Post-ASCT consolidation with elotuzumab, lenalidomide, and dexamethasone or elotuzumab, pomalidomide, and dexamethasone in high-risk and ultra-high-risk multiple myeloma: a retrospective single-center study

Patients with high-risk multiple-myeloma (HRMM) and ultra-high-risk multiple-myeloma (UHRMM) show rapid disease progression and shorter survival compared to those with standard-risk multiple-myeloma (SRMM). Lenalidomide maintenance after autologous stem cell transplant (ASCT) has shown inferior outcomes in this subgroup compared to SRMM, and there is an unmet need for improved post-ASCT therapy. This retrospective study, from September 2016 to March 2023, assesses elotuzumab combined with lenalidomide or pomalidomide and dexamethasone (ERd or EPd) as consolidation therapy post-ASCT for HRMM and UHRMM patients. HRMM (1 cytogenetic abnormality) and UHRMM (≥2 cytogenetic abnormalities) were defined using IMWG and mSMART criteria. Among 75 patients (median age: 64 years), 59 received ERd and 16 EPd. Median progression-free survival was 29.3 months for all patients, 32.7 months for HRMM, and 21.9 months for UHRMM. Elotuzumab plus an IMiD consolidation therapy post-ASCT demonstrated promising efficacy compared to other studies, with a fixed duration and reduced lenalidomide-related toxicity.