Dara-KRd induction and consolidation with double ASCT for high-risk NDMM
Touzeau C, Perrot A, Hulin C, et al. Daratumumab Carfilzomib Lenalidomide and Dexamethasone With Tandem Transplant in High-Risk Newly Diagnosed Myeloma. Blood. 2024; (doi: 10.1182/blood.2023023597).
Researchers have identified an intensive treatment to benefit individuals with newly diagnosed multiple myeloma (NDMM) who qualify for stem cell transplantation but face unfavorable outcomes due to cytogenetics. A Phase II clinical trial evaluated the intervention: six cycles of daratumumab-carfilzomib-lenalidomide-dexamethasone (D-KRd) induction, autologous stem cell transplantation (ASCT), four cycles of D-KRd consolidation, second ASCT, and 2 years of daratumumab-lenalidomide maintenance. To be eligible for enrollment, patients had to have NDMM; be treatment-naive; and have high-risk cytogenetics as indicated by the presence of del(17p), t(4;14) and/or t(14;16). The study sample included 50 participants, 72% of whom met the primary endpoint of feasibility by completing the second transplant. The overall response rate was 100% for those 36 patients, including a complete response rate of 81%. D-KRd plus double transplant was associated with favorable rates of minimal residual disease negativity, which reached 94% during the pre-maintenance stage, and high levels of progression-free and overall survival, which measured 80% and 91%, respectively, at a median follow-up of 33 months.