Impact of Dexamethasone (Dex) Dose Strength on Outcomes in Newly Diagnosed Multiple Myeloma (NDMM): A Secondary Analysis of SWOG Studies S0777 and S1211

Rahul Banerjee, MD discusses the impact of different strengths of dexamethasone (dex) on newly diagnosed multiple myeloma (NDMM).

Abstract title:

Impact of Dexamethasone (Dex) Dose Strength on Outcomes in Newly Diagnosed Multiple Myeloma (NDMM): A Secondary Analysis of SWOG Studies S0777 and S1211

What is the purpose of this trial?  

Dex is a key component of induction regimens for NDMM despite common toxicities including insomnia and anxiety. The E4A03 randomized trial (Rajkumar, Lancet Oncol 2010) demonstrated that dex dosed at 40 mg weekly outperformed higher-intensity dex and established this regimen as the standard of care for NDMM. In standard practice as well as clinical trials, however, dex doses are often reduced to 20 mg weekly or lower (if not stopped entirely) among older patients or among patients experiencing toxicities. As a first step toward establishing the equipoise of planned dex dose reductions in NDMM, we investigated outcomes with patients from two previous SWOG trials to understand the impact of dex dose reductions on post-induction outcomes.

In this video: 

Rahul Banerjee, MD discusses the impact of different strengths of dexamethasone (dex) on newly diagnosed multiple myeloma. 

Conclusion: 

From the abstract: "Dex dose reductions during induction had no impact on post-induction PFS and OS, even in the subset of patients who required significant dose reductions. Limitations of our post hoc analysis include heterogeneity between dex dosing schedules and lack of cytogenetic data for all patients. We could not discern specifically why dex was lowered, and it is possible that dex might have been lowered disproportionately commonly in patients who had achieved early responses and thus independently did better. Regardless, these results strongly suggest that maintaining dex 40 mg weekly for the entirety of NDMM induction may be unnecessary in the modern era. Cooperative efforts to study a planned dex de-escalation protocol (i.e., once no longer needed for symptom management or as a pre-medication) alongside patient-reported outcome assessments of symptom burden are being planned."

Trial information: Abstract #1066 (https://ash.confex.com/ash/2023/webprogram/Paper181744.html) 

Doctor bio: 

Dr. Rahul Banerjee is a physician-researcher who specializes in bone marrow and blood stem cell transplantation as well as cellular immunotherapies for the treatment of blood cancers. He has a particular interest in multiple myeloma, which results in the overproduction of blood components of the immune system known as plasma cells. Dr. Banerjee also treats patients with AL amyloidosis, a related but rarer condition that is treated similarly through close collaboration between cancer doctors, kidney doctors, and heart doctors. Those treatments may include transplantation using a reinfusion of a patient’s own blood stem cells or the use of CAR T cell therapies, where the patient’s stem cells are genetically modified to respond to the condition. In addition to novel treatments for multiple myeloma and AL amyloidosis, Dr. Banerjee's research interests involve digital health and supportive care to help patients as they undergo these treatments.