Combination therapy for fit (younger and older) newly diagnosed multiple myeloma patients: Data support carfilzomib, lenalidomide, and dexamethasone independent of cytogenetic risk status

In this invited paper, I was asked to critically review available literature and seek scientific and clinical evidence to argue in support of carfilzomib, lenalidomide, and dexamethasone (KRd) as the new default therapy for fit patients with a new diagnosis of multiple myeloma (MM). When performing the review of existing data and when writing this paper it became clear to me that both KRd and bortezomib, lenalidomide, and dexamethasone (RVd) are both recommended by established, well-respected expert guidelines. Importantly, the actual data behind guidelines supporting KRd and RVd come from phase II studies; thus, the level of scientific evidence behind KRd and RVd is the same. When reviewing efficacy and safety data for both regimens, I conclude that published peer-reviewed KRd original data are well in line with modern treatment goals for newly diagnosed MM patients: rapid, deep, and sustainable treatment effect with limited toxicity. Taken together, available scientific and clinical evidence favors KRd as the new default therapy for fit patients with a new diagnosis of MM. Original data support KRd independent of cytogenetic risk status; indeed, patients with standard-risk disease (which represents 75% of all newly diagnosed MM patients) have the strongest benefit of KRd.