Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Feb;104(2):1177-1186.
doi: 10.1007/s00277-025-06240-1. Epub 2025 Feb 15.

Real-world evidence of Carfilzomib, Lenalidomide and Dexamethasone (KRD) Scheme in patients with relapsed / refractory multiple myeloma

Antoni Garcia-Guiñon  1 , Paola Andrea Charry  2 , María Jimenez  3 , Josep Sarra  4 , Izarbe Delgado  5 , Laura Segura de la Torre  6 , Marta Santaliestra  7 , Marta Garcia-Pintos  8 , Yolanda Gonzalez  9 , Alicia Senin  10 , Cristina Motlló  11 , Eugènia Abella  12 , Elena Cabezudo  13 , Miquel Granell  14 , Esther Sancho  15 , María José Herranz  16 , Yasmina Seres  5 , Mercedes Gironella  3 , Juan Alfons Soler  6 , Josep Maria Marti-Tutusaus  7 , Ran Ben Azaiz  12 , Carlos Fernandez de Larrea  2
Affiliations
Observational Study

Real-world evidence of Carfilzomib, Lenalidomide and Dexamethasone (KRD) Scheme in patients with relapsed / refractory multiple myeloma

Antoni Garcia-Guiñon et al. Ann Hematol. 2025 Feb.

Abstract

Carfilzomib, lenalidomide and dexamethasone (KRd) is still a widely used treatment option for patients with relapsed / refractory multiple myeloma (RRMM). However, there is limited real-world evidence. Here we evaluated the efficacy and safety of KRd in patients with RRMM treated following the standard clinical practice of the hospitals in the Catalan region. This was a retrospective, observational study. The objective response rate (ORR) according to IMWG criteria was the primary endpoint. Secondary endpoints included progression-free survival (PFS) and overall survival (OS). The study planned to include at least 100-150 patients. In total 194 patients were included. Median age was 64 years (range: 40-88) and 56% were male. All patients had received bortezomib. Additionally, 89 patients (46%) had received thalidomide and 29 (15%) lenalidomide. The ORR was 73% (95% CI: 66-79), with 72 patients (37%) having ≥ CR. The ORR was influenced by ISS score, number of previous treatments and exposure to lenalidomide. The median PFS was 26 months and 2-years OS rate 70%. The ISS stage and LDH levels were independent prognostic factors of survival. In conclusion, the KRd scheme led to a good effectiveness comparable safety profile to the phase III clinical trial in patients with RRMM.

Keywords: Carfilzomib, lenalidomide and dexamethasone; Real-world; Relapsed/refractory multiple myeloma.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: CFL: Advisory boards: Janssen, BMS, Amgen, Pfizer, Sanofi, Beigene, GSK, Roche, Menarini; Honoraria: Amgen, Janssen, BMS, GSK, Sanofi, Pfizer, Beigene; Grants: BMS, Janssen, Amgen, GSK.EC: Advisory boards and honoraria: Janssen, Sanofi, GSK, Menarini, Amgen.CM: Advisory boards: Sanofi.YG: Janssen and Sanofi.The remaining co-authors have no competing interests.

Figures

Fig. 1
Fig. 1
Response rates to KRd. A Stacked bar graph illustrating the rate of sCR, CR, VGPR and PR in 194 patients included. B Forest plot illustrating with blue squares the ORR in patients subgroups. Whiskers indicate 95% CIs. C Swimmer plot showing responses over time in 141 patients who had a response to KRd scheme. Abbreviations: CR: complete response; CrCl: creatinine clearance; IMID: Immunomodulatory drug; ISS: International Staging System; LDH: lactate dehydrogenase; ORR: objective response rate; PR: partial response; R: lenalidomide treatment; sCR: stringent complete response; T: Thalidomide treatment; VGPR: very good partial response
Fig. 2
Fig. 2
PFS with KRd scheme in the real-world. A PFS in the overall population (blue line) with its 95% CI (blue shaded area). The dotted line indicates the 50% PFS probability. B Forest plot showing the correlation of baseline patients characteristics and PFS. Blue squares represent the hazard ratio of the subgroup with respect to the reference (ref) subgroup and whiskers indicate 95% CIs. Characteristics and values with white background correspond to the univariable analysis. The characteristics which show highest correlation with PFS in the univariable preliminary analysis are used to construct a multivariable model (shown with a grey background within the forest plot). Abbreviations: ASCT: autologous stem cell transplant; CrCl: creatinine clearance; IMID: Immunomodulatory drug; ISS: International Staging System; LDH: lactate dehydrogenase; PFS: progression-free survival; R: lenalidomide treatment; Ref: reference group; T: Thalidomide treatment
Fig. 3
Fig. 3
OS with KRd scheme in the real-world. A OS in the overall population (blue line) with its 95% CI (blue shaded area). The dotted line indicates the 50% OS probability. B Forest plot showing the correlation of baseline patients characteristics and OS. Blue squares represent the hazard ratio of the subgroup with respect to the reference (ref) subgroup and whiskers indicate 95% CIs. Characteristics and values with white background correspond to the univariable analysis. The characteristics which show highest correlation with OS in the univariable preliminary analysis are used to construct a multivariable model (shown with a grey background within the forest plot). Abbreviations: ASCT: autologous stem cell transplant; CrCl: creatinine clearance; IMID: Immunomodulatory drug; ISS: International Staging System; LDH: lactate dehydrogenase; OS: overall survival; R: lenalidomide treatment; Ref: reference group; T: Thalidomide treatment
Fig. 4
Fig. 4
Treatment-emergent adverse events with KRd in the real-world. The bar shows the percentage of patients with events grade 1-2 (light red) and grade 3-5 (dark red). The numbers within the bars show the number of patients who experienced the corresponding adverse event
See this image and copyright information in PMC

References

    1. Dimopoulos MA, Moreau P, Terpos E et al (2021) Multiple myeloma: EHA-ESMO clinical practice guidelines for diagnosis, treatment and follow-up†. Ann Oncol 32:309–322. 10.1016/j.annonc.2020.11.014 - PubMed
    1. Usmani SZ, Hoering A, Cavo M et al (2018) Clinical predictors of long-term survival in newly diagnosed transplant eligible multiple myeloma - an IMWG Research Project. Blood Cancer J 8:123. 10.1038/s41408-018-0155-7 - PMC - PubMed
    1. Cavo M, Gay FM, Patriarca F et al (2017) Double autologous stem cell transplantation significantly prolongs progression-free survival and overall survival in comparison with single autotransplantation in newly diagnosed multiple myeloma: an analysis of phase 3 EMN02/HO95 study. Blood 130:401. 10.1182/blood.V130.Suppl_1.401.401
    1. Cavo M, Gay F, Beksac M et al (2020) Autologous haematopoietic stem-cell transplantation versus bortezomib-melphalan-prednisone, with or without bortezomib-lenalidomide-dexamethasone consolidation therapy, and lenalidomide maintenance for newly diagnosed multiple myeloma (EMN02/HO95): a multicentre, randomised, open-label, phase 3 study. Lancet Haematol 7:e456–e468. 10.1016/S2352-3026(20)30099-5 - PubMed
    1. Attal M, Lauwers-Cances V, Hulin C et al (2017) Lenalidomide, Bortezomib, and dexamethasone with transplantation for Myeloma. N Engl J Med 376:1311–1320. 10.1056/NEJMoa1611750 - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources