Muhamad Alhaj Moustafa, MD, Mayo Clinic, Jacksonville, Florida, presents findings from a study comparing daratumumab plus lenalidomide and dexamethasone (DRd) compared to daratumumab plus pomalidomide and dexamethasone (DPd) for lenalidomide-exposed patients with relapsed or refractory multiple myeloma (MM) at Mayo Clinic.
These results were presented at the 62nd Annual American Society of Hematology (ASH) Annual Meeting.
Transcript
Hello. I am Muhamad Alhaj Moustafa, the chief hematology oncology fellow at the Mayo Clinic in Florida.
I'm summarizing the results of our retrospective cohort study titled "Daratumumab Plus Lenalidomide and Dexamethasone (DRd) Compared to Daratumumab Plus Pomalidomide and Dexamethasone (DPd) in Relapsed Lenalidomide-Exposed or Refractory Multiple Myeloma Patients: The Mayo Clinic Experience."
Daratumumab is commonly used in combination with lenalidomide or pomalidomide. Pomalidomide is usually added to daratumumab in subsequent lines of therapy in cases of prior lenalidomide exposure or refractoriness.
However, there are no studies comparing outcomes of patients receiving DRd to DPd and lenalidomide-exposed or refractory myeloma. It is unknown which combination we should use.
We identified all patients who received daratumumab for multiple myeloma at the Mayo Clinic between January 2015 and April 2019. We excluded all patients who did not receive at least one full cycle of lenalidomide prior to daratumumab.
We grouped patients into lenalidomide-exposed group, those patients received at least 1 full cycle of lenalidomide without progression while on lenalidomide, and len-refractory group defined by progression on full-dose or maintenance lenalidomide during treatment or within 60 days of stopping lenalidomide.
We look specifically at those who received DRd or DPd and had 1-4 lines of therapy prior to daratumumab. Out of 411 evaluable patients who received daratumumab, 162 patients included in the study; 67 patients were lenalidomide-exposed and 95 patients were lenalidomide-refractory.
There was statistically no significant difference between patients who received DRd and DPd in terms of age, gender, race, proportion exposed or refractory to bortezomib, number of prior lines of treatment, or high risk status. Both groups had similar median follow-up time of about 30 months.
When we looked at the lenalidomide-exposed but not refractory patient, there was no difference in overall response rate, progression-free survival, or overall survival between patients who received DRd versus DPd.
However, in lenalidomide-refractory patients, there was higher overall response rate of 84% in the DRd group compared to 58% in the DPd group but no significant difference in progression-free survival or overall survival.
We looked at the high-risk patients as well who received DRd or DPd in the second or third lines of therapy. The 29 lenalidomide-refractory patients, there was no statistically significant difference in median progression-free survival—18 months for the DRd group compared to 6 months for the DPd group. Similarly, there was no difference in median overall survival.
We concluded that regardless of prior use of lenalidomide, DRd is at least equivalent to DPd. However, prospective studies should be done to confirm these observations. Thank you.
