Elotuzumab plus lenalidomide and dexamethasone for newly diagnosed multiple myeloma: a randomized, open-label, phase 2 study in Japan

  • Kohmei KuboEmail author
  • Mitsuo Hori
  • Kensuke Ohta
  • Hiroshi Handa
  • Kiyohiko Hatake
  • Morio Matsumoto
  • Shotaro Hagiwara
  • Kazuteru Ohashi
  • Chiaki Nakaseko
  • Kenshi Suzuki
  • Shigeki Ito
  • Gen Kinoshita
  • Suresh G. Shelat
  • Masafumi Miyoshi
  • Naoki Takezako
Original Article


Novel therapies are needed for patients with newly diagnosed multiple myeloma (NDMM). Elotuzumab plus lenalidomide and dexamethasone (ELd) is approved for the treatment of relapsed/refractory multiple myeloma (RRMM). This phase 2 study in Japan evaluated ELd vs lenalidomide and dexamethasone (Ld) in patients with NDMM who were ineligible for stem cell transplantation. Elotuzumab infusion was accelerated to 5 mL/min by dose 3, cycle 1, allowing most subsequent infusions to be completed within 1 h. The primary endpoint was overall response rate (ORR) in the ELd arm. Secondary endpoints were the difference in ORR between treatments, and progression-free survival (PFS). Patients were randomized to ELd (n = 40) or Ld (n = 42); median number of treatment cycles was 13 (ELd) and 12 (Ld). In the ELd arm, ORR was 88% [70% confidence interval (CI) 80–93]. The estimated difference in ORR between treatments was 13% (95% CI  − 4, 30) in favor of ELd. Progression-free survival data were immature. Safety was consistent with previous findings of ELd in Japanese patients with RRMM. No infusion reactions occurred at the maximum rate of 5 mL/min, which was used in 89% of elotuzumab infusions. ELd may be an effective, well-tolerated frontline treatment for patients with NDMM ineligible for stem cell transplantation.


Multiple myeloma Newly diagnosed Elotuzumab Stem cell transplantation-ineligible 



The study was funded by Bristol-Myers Squibb K.K. Under the direction of the authors, professional medical writing assistance in the form of writing the first draft, drafting figures and tables, and collating author comments was provided by Laura Yee of Caudex, funded by Bristol-Myers Squibb K.K.

Author contributions

KK, MH, KO, HH, KH, MM, SH, KO, CN, KS, SI, and NT participated in data acquisition. GK performed data analysis. GK, SGS, and MM contributed to the conception and design of the study. All authors participated in interpreting the data, critically reviewed the manuscript, and approved the final version for submission.


The study sponsor, Bristol-Myers Squibb K.K., provided the study drug and collaborated with the investigators to design the study and to collect and analyze the data. Editorial assistance from professional medical writers was funded by the sponsor.

Compliance with ethical standards

Conflict of interest

MH reports post-marketing surveillance study fees from Celgene, Fujifilm RI Pharma, and Shire Japan. K Ohta reports honoraria from Bristol-Myers Squibb K.K., Celgene K.K., Janssen Pharmaceutical K.K., Novartis Pharma K.K., Ono Pharmaceutical Co. Ltd, and Takeda Pharmaceutical Co. Ltd. HH reports research grants from Celgene, Takeda Pharmaceutical, Astellas Pharma, Daiichi Sankyo, Sanofi, MSD, Kyowa Hakko Kirin, Chugai Pharmaceutical, Pfizer, Otsuka Pharmaceutical, and Ono Pharmaceutical, and honoraria from Celgene, Takeda Pharmaceutical, Daiichi Sankyo and Ono Pharmaceutical. KH reports honoraria from Bristol-Myers Squibb K.K., Ono Pharmaceutical Co. Ltd, Takeda Pharmaceutical Co. Ltd., Taiho Pharmaceutical, Johnson & Johnson, Celgene, AbbVie, Eisai, MSD, Kyowa Hakko Kirin, Novartis and Chugai Pharmaceutical, and consultancy from Otsuka Pharmaceutical and Meiji Seika Pharma. M Matsumoto reports honoraria from Janssen Pharmaceutical, Celgene, Takeda Pharmaceutical, Ono Pharmaceutical, Bristol-Myers Squibb K.K., Daiichi Sankyo, and Kyowa Hakko Kirin. SH reports a grant for investigator sponsored research from Bristol-Myers Squibb K.K. CN reports honoraria from Bristol-Myers Squibb K.K., Celgene K.K., Janssen Pharmaceutical K.K., Novartis Pharma K.K., and Takeda Pharmaceutical Co. Ltd, and research funding from Bristol-Myers Squibb K.K., Ono Pharmaceutical Co. Ltd, and Takeda Pharmaceutical Co. Ltd. KS reports personal fees from Celgene, Janssen Pharmaceutical, Takeda, Novartis, Bristol-Myers Squibb K.K., and Sanofi. SI reports honoraria from Bristol-Myers Squibb K.K., Celgene K.K., Janssen Pharmaceutical K.K., Ono Pharmaceutical Co. Ltd, and Takeda Pharmaceutical Co. Ltd. GK and M Miyoshi report employment by Bristol-Myers Squibb K.K. SGS reports employment by and equity ownership in Bristol-Myers Squibb. K.K., K Ohashi, and NT declare no competing financial interests.

Data sharing statement

The Bristol-Myers Squibb policy on data sharing may be found at

Supplementary material

12185_2019_2757_MOESM1_ESM.pdf (435 kb)
Supplementary material 1 (PDF 434 kb)


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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  • Kohmei Kubo
    • 1
    Email author
  • Mitsuo Hori
    • 2
  • Kensuke Ohta
    • 3
    • 4
  • Hiroshi Handa
    • 5
  • Kiyohiko Hatake
    • 6
  • Morio Matsumoto
    • 7
  • Shotaro Hagiwara
    • 8
    • 9
  • Kazuteru Ohashi
    • 10
  • Chiaki Nakaseko
    • 11
    • 12
  • Kenshi Suzuki
    • 13
  • Shigeki Ito
    • 14
  • Gen Kinoshita
    • 15
  • Suresh G. Shelat
    • 16
  • Masafumi Miyoshi
    • 15
  • Naoki Takezako
    • 17
  1. 1.Department of HematologyAomori Prefectural Central HospitalAomoriJapan
  2. 2.Department of HematologyIbaraki Prefectural Central HospitalKasamaJapan
  3. 3.Department of HematologyOsaka Saiseikai Nakatsu HospitalOsakaJapan
  4. 4.Hematology Ohta ClinicShinsaibashiJapan
  5. 5.Department of HematologyGunma University HospitalMaebashiJapan
  6. 6.Department of Lymphoma/Hematologic Malignancy CenterMita Hospital, International University of Health and WelfareTokyoJapan
  7. 7.Department of HematologyNational Hospital Organization Shibukawa Medical CenterShibukawaJapan
  8. 8.Division of Hematology, Internal MedicineNational Center for Global Health and Medicine HospitalTokyoJapan
  9. 9.Department of HematologyTokyo Women’s Medical UniversityTokyoJapan
  10. 10.Hematology DivisionTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
  11. 11.Department of HematologyChiba University HospitalChibaJapan
  12. 12.Department of Hematology, School of MedicineInternational University of Health and WelfareNaritaJapan
  13. 13.Department of HematologyJapanese Red Cross Medical CenterTokyoJapan
  14. 14.Department of Clinical OncologyIwate Medical University HospitalMoriokaJapan
  15. 15.Bristol-Myers Squibb K.K.TokyoJapan
  16. 16.Bristol-Myers SquibbPrincetonUSA
  17. 17.Department of HematologyNational Hospital Organization Disaster Medical CenterTokyoJapan

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