Index treatment regimens received by patients with lenalidomide-refractory RRMM previously treated with 1 to 3 prior lines of treatment
| Treatment regimen, n (%) . | Overall . | 1 prior LOT (LOT 2) . | 2 prior LOT (LOT 3) . | 3 prior LOT (LOT 4) . |
|---|---|---|---|---|
| (N = 1455) . | (n = 561) . | (n = 566) . | (n = 328) . | |
| NCCN-preferred regimens for lenalidomide-refractory 1-3 PL RRMM∗ | ||||
| DPd | 192 (13.2) | 58 (10.3) | 80 (14.1) | 54 (16.5) |
| KPd | 104 (7.1) | 53 (9.4) | 34 (6.0) | 17 (5.2) |
| DVd | 95 (6.5) | 48 (8.6) | 32 (5.7) | 15 (4.6) |
| DKd | 56 (3.8) | 24 (4.3) | 25 (4.4) | 7 (2.1) |
| PVd | 39 (2.7) | 23 (4.1) | 11 (1.9) | 5 (1.5) |
| IxaPd | 14 (1.0) | 4 (0.7) | 6 (1.1) | 4 (1.2) |
| IsaKd | 3 (0.2) | 1 (0.2) | 2 (0.4) | 0 |
| IsaPd | 3 (0.2) | 0 | 2 (0.4) | 1 (0.3) |
| Total | 506 (34.8) | 211 (37.6) | 192 (33.9) | 103 (31.4) |
| Other regimens recommended by NCCN for 1-3 PL RRMM (not specific for lenalidomide refractory)† | ||||
| Kd | 102 (7.0) | 38 (6.8) | 39 (6.9) | 25 (7.6) |
| CyBorD | 57 (3.9) | 43 (7.7) | 11 (1.9) | 3 (0.9) |
| CyKd | 26 (1.8) | 12 (2.1) | 10 (1.8) | 4 (1.2) |
| EloPd | 26 (1.8) | 2 (0.4) | 15 (2.7) | 9 (2.7) |
| PCyd | 5 (0.3) | 2 (0.4) | 2 (0.4) | 1 (0.3) |
| IxaCyd | 3 (0.2) | 0 | 2 (0.4) | 1 (0.3) |
| Vdoxo | 3 (0.2) | 3 (0.5) | 0 | 0 |
| DCyVd | 3 (0.2) | 3 (0.5) | 0 | 0 |
| EloVd | 1 (0.1) | 0 | 1 (0.2) | 0 |
| SVd | 1 (0.1) | 0 | 0 | 1 (0.3) |
| Total | 227 (15.6) | 103 (18.4) | 80 (14.1) | 44 (13.4) |
| Regimens listed by NCCN as useful in certain circumstances (not specific for lenalidomide refractory) | ||||
| D monotherapy | 121 (8.3) | 43 (7.7) | 44 (7.8) | 34 (10.4) |
| Pd | 112 (7.7) | 26 (4.6) | 54 (9.5) | 32 (9.8) |
| Vd | 97 (6.7) | 51 (9.1) | 32 (5.7) | 14 (4.3) |
| Sd | 1 (0.1) | 0 | 0 | 1 (0.3) |
| KCyTd | 1 (0.1) | 1 (0.2) | 0 | 0 |
| Ven + d | 2 (0.1) | 2 (0.4) | 0 | 0 |
| Total | 334 (23.0) | 123 (21.9) | 130 (23.0) | 81 (24.7) |
| NCCN-recommended for later-line relapses (not specific for lenalidomide-refractory RRMM) | ||||
| Bendamustine | 3 (0.2) | 0 | 1 (0.2) | 2 (0.6) |
| Cyclophosphamide | 1 (0.1) | 1 (0.2) | 0 | 0 |
| Total | 4 (0.3) | 1 (0.2) | 1 (0.2) | 2 (0.6) |
| Regimens not recommended by NCCN | ||||
| Other MM treatment‡ | 137 (9.4) | 27 (4.8) | 65 (11.5) | 45 (13.7) |
| Other D regimens | 56 (3.8) | 18 (3.2) | 23 (4.1) | 15 (4.6) |
| Ixad | 42 (2.9) | 20 (3.6) | 18 (3.2) | 4 (1.2) |
| Total | 235 (16.2) | 65 (11.6) | 106 (18.7) | 64 (19.5) |
| Clinical trials | 48 (3.3) | 16 (2.9) | 19 (3.4) | 13 (4.0) |
| Other treatments§ | 101 (6.9) | 42 (7.5) | 38 (6.7) | 21 (6.4) |
| Treatment regimen, n (%) . | Overall . | 1 prior LOT (LOT 2) . | 2 prior LOT (LOT 3) . | 3 prior LOT (LOT 4) . |
|---|---|---|---|---|
| (N = 1455) . | (n = 561) . | (n = 566) . | (n = 328) . | |
| NCCN-preferred regimens for lenalidomide-refractory 1-3 PL RRMM∗ | ||||
| DPd | 192 (13.2) | 58 (10.3) | 80 (14.1) | 54 (16.5) |
| KPd | 104 (7.1) | 53 (9.4) | 34 (6.0) | 17 (5.2) |
| DVd | 95 (6.5) | 48 (8.6) | 32 (5.7) | 15 (4.6) |
| DKd | 56 (3.8) | 24 (4.3) | 25 (4.4) | 7 (2.1) |
| PVd | 39 (2.7) | 23 (4.1) | 11 (1.9) | 5 (1.5) |
| IxaPd | 14 (1.0) | 4 (0.7) | 6 (1.1) | 4 (1.2) |
| IsaKd | 3 (0.2) | 1 (0.2) | 2 (0.4) | 0 |
| IsaPd | 3 (0.2) | 0 | 2 (0.4) | 1 (0.3) |
| Total | 506 (34.8) | 211 (37.6) | 192 (33.9) | 103 (31.4) |
| Other regimens recommended by NCCN for 1-3 PL RRMM (not specific for lenalidomide refractory)† | ||||
| Kd | 102 (7.0) | 38 (6.8) | 39 (6.9) | 25 (7.6) |
| CyBorD | 57 (3.9) | 43 (7.7) | 11 (1.9) | 3 (0.9) |
| CyKd | 26 (1.8) | 12 (2.1) | 10 (1.8) | 4 (1.2) |
| EloPd | 26 (1.8) | 2 (0.4) | 15 (2.7) | 9 (2.7) |
| PCyd | 5 (0.3) | 2 (0.4) | 2 (0.4) | 1 (0.3) |
| IxaCyd | 3 (0.2) | 0 | 2 (0.4) | 1 (0.3) |
| Vdoxo | 3 (0.2) | 3 (0.5) | 0 | 0 |
| DCyVd | 3 (0.2) | 3 (0.5) | 0 | 0 |
| EloVd | 1 (0.1) | 0 | 1 (0.2) | 0 |
| SVd | 1 (0.1) | 0 | 0 | 1 (0.3) |
| Total | 227 (15.6) | 103 (18.4) | 80 (14.1) | 44 (13.4) |
| Regimens listed by NCCN as useful in certain circumstances (not specific for lenalidomide refractory) | ||||
| D monotherapy | 121 (8.3) | 43 (7.7) | 44 (7.8) | 34 (10.4) |
| Pd | 112 (7.7) | 26 (4.6) | 54 (9.5) | 32 (9.8) |
| Vd | 97 (6.7) | 51 (9.1) | 32 (5.7) | 14 (4.3) |
| Sd | 1 (0.1) | 0 | 0 | 1 (0.3) |
| KCyTd | 1 (0.1) | 1 (0.2) | 0 | 0 |
| Ven + d | 2 (0.1) | 2 (0.4) | 0 | 0 |
| Total | 334 (23.0) | 123 (21.9) | 130 (23.0) | 81 (24.7) |
| NCCN-recommended for later-line relapses (not specific for lenalidomide-refractory RRMM) | ||||
| Bendamustine | 3 (0.2) | 0 | 1 (0.2) | 2 (0.6) |
| Cyclophosphamide | 1 (0.1) | 1 (0.2) | 0 | 0 |
| Total | 4 (0.3) | 1 (0.2) | 1 (0.2) | 2 (0.6) |
| Regimens not recommended by NCCN | ||||
| Other MM treatment‡ | 137 (9.4) | 27 (4.8) | 65 (11.5) | 45 (13.7) |
| Other D regimens | 56 (3.8) | 18 (3.2) | 23 (4.1) | 15 (4.6) |
| Ixad | 42 (2.9) | 20 (3.6) | 18 (3.2) | 4 (1.2) |
| Total | 235 (16.2) | 65 (11.6) | 106 (18.7) | 64 (19.5) |
| Clinical trials | 48 (3.3) | 16 (2.9) | 19 (3.4) | 13 (4.0) |
| Other treatments§ | 101 (6.9) | 42 (7.5) | 38 (6.7) | 21 (6.4) |
No patients received CAR T-cell therapy, bispecific therapy, bendamustine + Kd, bendamustine + Vd, SDd, SKd, SPd, DCEP (dexamethasone, cyclophosphamide, etoposide, and cisplatin), or VTDPACE (bortezomib [Velcade], thalidomide, dexamethasone, platinum [cisplatin], Adriamycin [doxorubicin], cyclophosphamide, and etoposide).
Bor, bortezomib; CAR, chimeric antigen receptor; Cy, cyclophosphamide; d, dexamethasone; D, daratumumab; doxo, doxorubicin; DVd, daratumumab, bortezomib, and dexamethasone; Elo, elotuzumab; Isa, isatuximab; Ixa, ixazomib; K, carfilzomib; P, pomalidomide; S, selinexor; T, tamoxifen; V, Velcade/bor; Ven, venetoclax.
NCCN Guidelines v3.2023, dated 8 December 2022, were current at the time of the analysis.
Regimens listed as “other recommended” or “useful in certain circumstances” in NCCN Guidelines v3.2023 for RRMM, although not specifically for lenalidomide-refractory RRMM.
Other MM combinations, including ≥1 PI, immunomodulatory drug, and/or anti-CD38 indicated for RRMM that does not reflect NCCN recommendations. See NCCN Guidelines for Multiple Myeloma v4.2024 for current recommendations.
Other treatment regimens primarily consisted of chemotherapies, the vast majority of which were used by <10 patients; includes some lenalidomide-containing regimens, as lenalidomide-refractory patients could be rechallenged with lenalidomide in a later LOT.