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Observational Study
. 2025 May;121(5):670-683.
doi: 10.1007/s12185-025-03927-z. Epub 2025 Mar 20.

Real-world effectiveness of ixazomib, lenalidomide and dexamethasone in Asians with relapsed/refractory multiple myeloma

Soo Chin Ng #  1 , Joon-Ho Moon #  2 , Sung Soo Park  3 , Youngil Koh  4 , Ji Hyun Lee  5 , Hyeon-Seok Eom  6 , Ho-Jin Shin  7 , Sung Hoon Jung  8 , Young Rok Do  9 , Gilbert Wilfred  10 , Azlan Husin  11 , Hyo Jung Kim  12 , SFadilah Abdul Wahid  13 , Myung-Won Lee  14 , Hye-Won Heo  15 , Kihyun Kim  16 , Suporn Chuncharunee  17
Affiliations
Observational Study

Real-world effectiveness of ixazomib, lenalidomide and dexamethasone in Asians with relapsed/refractory multiple myeloma

Soo Chin Ng et al. Int J Hematol. 2025 May.

Abstract

Randomized clinical trials have shown ixazomib, lenalidomide and dexamethasone (IRd) to be efficacious and safe in Asian patients with relapsed/refractory multiple myeloma (RRMM); however, real-world data are limited. The APEX study was a multicenter, observational cohort study of IRd conducted at 16 sites across South Korea, Malaysia, and Thailand. Overall, 104 patients treated with IRd during 2016-2023 were enrolled; data were collected by retrospective chart review and 6-month prospective follow-up. Median age at IRd initiation was 64.0 years. The primary endpoints of median time to next treatment (TTNT) and overall response rate (ORR) were 32.1 months and 72.1%, respectively (though ORR varied across countries). The secondary endpoint of median progression-free survival was 27.7 months, while median overall survival was not reached. Median TTNT and ORR were higher in elderly patients (≥65 and/or ≥70 years) than in the overall population. Adverse events occurred in 90.4% and serious adverse events occurred in 29.8% of all patients; common Grade ≥ 3 adverse drug reactions were pneumonia (9.6%), neutropenia (7.7%), and gastroenteritis (2.9%). This study demonstrated that IRd was safe and effective in real-world practice in Asia, including for elderly patients, and the results are aligned with TOURMALINE-MM1 and other real-world studies.

Keywords: Asia; Ixazomib; Real-world; Relapsed refractory multiple myeloma.

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Conflict of interest statement

Declarations. Conflicts of interest: Hye-won Heo was an employee of Takeda Pharmaceuticals Korea Co., Ltd. Ji Hyun Lee has received honoraria/research funding from Takeda, Amgen, Janssen, Celgene-BMS, Sanofi and JW Pharmaceutical, and was a consultant for Takeda, Amgen and Janssen. Youngil Koh holds a leadership position at Genome Opinion, holds stock/options in Genome Opinion, Curocell, Proteina and Tomocube, and has received research funding from Sanofi-Genzyme and Roche. Soo Chin Ng has received consultation fees/honorarium for participation in advisory boards from Roche, AstraZeneca, Novartis and BeiGene. The other authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Patient disposition
Fig. 2
Fig. 2
Swimmer plot for all patients. A actual event; C censored event; CR complete response; IRd ixazomib, lenalidomide and dexamethasone; OS overall survival; PD progressive disease; PFS progression free survival; PR partial response; sCR stringent complete response; TTNT time to next treatment; VGPR very good partial response
Fig. 3
Fig. 3
Kaplan–Meier analysis of progression-free survival. IRd ixazomib, lenalidomide and dexamethasone
See this image and copyright information in PMC

References

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    1. Lee JH, Kim SH, Kim HR, Min CK, Lee JJ, Shin HJ, et al. Real-world toxicity and effectiveness of ixazomib, lenalidomide, and dexamethasone in Korean patients with relapsed and/or refractory multiple myeloma. Int J Hematol. 2023;117(2):225–35. - PubMed
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