BY: Kerri Fitzgerald
A real-world, multicenter study supported findings from the pivotal ICARIA-MM clinical trial, showing that isatuximab, pomalidomide, and dexamethasone (IsaPd) was an efficacious and tolerable combination for relapsed or refractory multiple myeloma (MM).
Enrica Antonia Martino, of Azienda Ospedaliera Annunziata in Italy, and colleagues outlined their findings in a Letter to the Editor published in Haematologica.
This study included 270 patients treated with IsaPd at 51 Italian centers between January 2021 and June 2024. Compared with the ICARIA-MM cohort, this study population had a lower incidence of renal impairment (39.0% vs 29.3%), a higher proportion of high-risk cytogenetics (16.0% vs 29.3%), and included daratumumab-refractory patients (20% vs 0%).
At last follow-up, the overall response rate (ORR) was 74.1%, including 14.8% in complete remission (CR). Responses were higher than the ICARIA-MM cohort (60% ORR; 4.5% CR).
After a median follow-up of 23.5 months, 57.8% of patients experienced disease progression or death. Median progression-free survival was 15.7 months, which was also longer than the 11.5 months observed in the ICARIA-MM study.
Median overall survival (OS) was not reached; the ICARIA-MM trial reported a median OS of 24.6 months.
A little more than a third (38.5%) of patients received subsequent treatment after discontinuing IsaPd, with a median time to next treatment of 17.7 months and a 2-year retreatment probability of 39%. Patient received a median of 11 IsaPd courses, with 61.9% discontinuing treatment, mostly due to disease progression (50%).
Grade 3/4 neutropenia (56.3%), thrombocytopenia (15.9%), and anemia (13.7%) occurred. The incidence of grade 3/4 neutropenia and thrombocytopenia was lower than what was reported in the ICARIA-MM trial, “possibly attributed to the more diverse population and underreporting of adverse events in real-world settings,” the authors noted.
“IsaPd is effective and safe in a real-world setting for [relapsed or refractory] MM patients who received 2 prior lines of therapy,” the researchers concluded.
Reference
Martino EA, Derudas D, Rossi E, et al. Isatuximab, pomalidomide, and dexamethasone as salvage therapy for patients with multiple myeloma: the Italian, multicenter, retrospective clinical experience with 270 cases outside of controlled clinical trials. Haematologica. 2025;110(4):1028-1033. doi:10.3324/haematol.2024.286658
