A REAL-WORLD EFFICACY AND SAFETY ANALYSIS OF COMBINED CARFILZOMIB, LENALIDOMIDE AND DEXAMETHASONE (KRd) IN RELAPSED/REFRACTORY MULTIPLE MYELOMA.

Carfilzomib-lenalidomide-dexamethasone (KRd) has been approved for the treatment of relapsed/refractory multiple myeloma (RRMM). We conducted a retrospective analysis of 197 RRMM patients (pts) between January 2016 and March 2018 in 6 italian hematologic centers, with the aim to evaluate efficacy and safety of KRd in real-life. At KRd initiation 27% carried high risk cytogenetic abnormalities (HRCA) [del17p and/or t(4;14) and/or t(14;16)], median number of prior lines of therapy was 2 (1-8), nearly all pts (96%) received prior bortezomib (18% refractory) while 45% were exposed to lenalidomide (R) (22% refractory). At the median of 12.5 months, 52% of the pts had discontinued treatment, mainly (66%) for progression. Main grade 3-4 AEs were neutropenia (21%), infections (11%) and hypertension (6%). Overall, the response rate was 88%. The median PFS was 19.8 months and 1-year OS rate was 80.6%. By subgroup analysis, extended PFS and OS were observed for pts who received ≤2 prior lines of therapy (HR=0.42, p<0.001 and HR=0.35, p=0.001, respectively), not refractory to prior R (HR=0.37, p<0.001, and HR=0.47, p=0.024), without HRCA (HR=0.33, p=0.005 and HR=0.26, p= 0.016) and achieving ≥VGPR (HR=0.17, p<0.001 and HR=0.18, p<0.001). In conclusion, KRd demonstrated to be effective in RRMM patients treated in real-world setting, without new safety concerns. Better survival outcomes emerged for pts with ≤2 prior lines of therapy, achieving at least a VGPR, and without HRCA. This article is protected by copyright. All rights reserved.