A real-world retrospective-prospective analysis of efficacy and safety of combined ixazomib, lenalidomide, and dexamethasone in relapsed/refractory multiple myeloma: The northern Italy experience

Abstract

Introduction: Ixazomib, lenalidomide, and dexamethasone (IRd) have been approved for the treatment of relapsed/refractory multiple myeloma (RRMM) based on the results of the TOURMALINE-MM1.

Objectives and methods: We conducted a retrospective-prospective analysis of 106 RRMM patients (pts) treated with IRd in 21 centers in Northern Italy, with the aim to evaluate the efficacy and safety of IRd in real life.

Results: At IRd initiation, 34% of pts were aged ≥75 (median 72.5), 8.5% had an ECOG performance status ≥2, 54.7% of evaluable pts carried high-risk cytogenetic abnormalities [del17p and/or t(4;14) and/or t(14;16) and/or 1 g gain/amp], 60.2% had received ≥2 prior lines of therapy (pLoT), 57.5% were lenalidomide (Len)-exposed (including both Len-sensitive and Len-refractory pts), and 22% were Len-refractory. Main G ≥3 adverse events (AEs) were thrombocytopenia (16%) and neutropenia (12.3%). G ≥3 non-hematologic AEs included infections (9.4%) and GI toxicity (diarrhea 5.7%, hepatotoxicity 2.8%), VTE, skin rash, and peripheral neuropathy were mainly G1-2. The overall response rate was 56.4% (≥VGPR 30%). With a median follow-up of 38 m, median PFS (mPFS) was 16 m and the 1-year OS rate was 73%. By subgroup analysis, an extended PFS was observed for pts achieving ≥VGPR (mPFS 21.2 m), time from diagnosis to IRd ≥5 years (26.2 m), 1 pLoT (34.4 m), Len-naïve (NR), age ≥70 (20 m). In pts exposed to Len, non-refractory in any prior line and immediately prior to IRd, mPFS was 16 and 18 m, respectively. An inferior PFS was seen in Len-refractory pts (4.6 m). By multivariate analysis, independent predictors of PFS were age ≥70 (HR 0.6), time from diagnosis ≥5 years (HR 0.32), refractoriness to Len in any prior line (HR 3.33), and immediately prior (HR 4.31).

Conclusion: IRd might be effective and safe in RRMM pts with an indolent disease, in early lines of treatment, and who proved Len-sensitive, independent of age, and cytogenetic risk.

Keywords: efficacy; ixazomib–lenalidomide–dexamethasone; lenalidomide‐exposed; lenalidomide‐refractory; real‐life; relapsed/refractory multiple myeloma; safety.

FIGURE 1

Kaplan–Meier curves of PFS (A) and OS (B) of the overall study population.

FIGURE 2

Kaplan–Meier curves of PFS based on the number of pLoT (A), time from diagnosis (B), age (C), best response (D), exposure/refractoriness to Len in any prior line (E) and immediately prior to IRd (F), exposure/refractoriness to prior bortezomib (G), R‐ISS (H), R2‐ISS (I). Bor‐exp,bortezomib‐exposed; Len‐exp,lenalidomide‐exposed; NR,not reached; pLoT,prior lines of therapy; R2‐ISS, second revision of the International Staging System; R‐ISS,Revised International Staging System; VGPR,very good partial response; y,years.

FIGURE 3

Multivariate analysis of variables affecting PFS. len,lenalidomide; VGPR,very good partial response; y,years. ^*** p<0.001; ^** p<0.01; ^* p<0.05.