DR LOVE: Can you talk a little bit about the pragmatics of using RVd maintenance, this strategy that you’ve talked about with the high-risk patient and how long you use it and how the patients do?

DR LONIAL: Yes. So, I mean, I think the pragmatics are that delivery of long-term IV therapy is really untenable. And so what I mean by that is, giving IV bortezomib for 3 years is really not a viable option. On the other hand, giving it subcutaneously once a week was a viable option, and that’s what we did in that trial experience.

What we’re now beginning to experiment with to build on that experience is replacing the bortezomib with ixazomib, because again, that then becomes an all-oral combination for high-risk patients that so far has yielded encouraging results.

DR LOVE: Yes. That was really the first thing I thought about when I heard about oral proteasome inhibitors. And I knew there was this interest in maintenance. Have you had patients now on, I guess, really, ixazomib for prolonged periods of time? And how do you find people do?

DR LONIAL: Yes. I mean, we’ve had — we were on the original Phase I that was published in Lancet Oncology that Shaji Kumar did with IRd up front followed by maintenance I afterwards. The longest we’ve had a patient on, I think, was four and a half years. And that patient — once you get the dose and schedule right early on in the disease course, they do fine after that.

Non-Hodgkin lymphoma (NHL), Hodgkin lymphoma and chronic lymphocytic leukemia (CLL)

Acute and chronic leukemias and myeloproliferative neoplasms

Multiple myeloma (MM)