Long-Term Survival with Daratumumab, Lenalidomide and Dexamethasone in Transplant-Ineligible Newly Diagnosed Multiple Myeloma Patients—A Survey from Two Italian Centers

TL;DR

This study shows that the D-Rd treatment combination leads to long-term survival in transplant-ineligible multiple myeloma patients.

Contribution

The study confirms the effectiveness of D-Rd as a first-line therapy for transplant-ineligible patients.

Findings

90% of patients achieved at least a partial response with D-Rd treatment.

59% of patients achieved a very good partial response or better.

Higher beta-2-microglobulin levels correlated with lower treatment response.

Abstract

Background: Multiple myeloma (MM) is a clonal plasma cell neoplasm representing the second most common hematological malignancy. The combination of daratumumab, lenalidomide and dexamethasone (D-Rd) was first approved by the EMA (European Medicines Agency) for the treatment of relapsed/refractory multiple myeloma (RRMM) patients, and was subsequently approved for first-line therapy, based on the results of POLLUX and MAIA trials, respectively. Methods: In this survey, we retrospectively collected data from 96 consecutive transplant-ineligible newly diagnosed multiple myeloma (TIE-NDMM) patients treated with the D-Rd combination. Results: The median age was 73 years; the median progression free survival (mPFS) and median overall survival (mOS) were not reached (NR); the overall response rate (ORR), defined as patients who obtained at least a partial response (PR), was 90%; 59% of patients achieved a very good partial response (VGPR) or better. A strong negative correlation was observed between treatment response and elevated beta-2-microglobulin levels. Conclusions: This study confirms the efficacy of the D-Rd combination as first-line therapy for TIE-NDMM patients, suggesting that achieving at least a PR—and particularly a VGPR—may represent a strong predictor of long-term remission and survival, even in the era of new combinations based on the use of quadruplets.

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