[The Efficacy and Safety of Daratumumab-Based Combination Therapy in Multiple Myeloma]
Fan Gao1, Yu-Lan Zhou1, Shi-Xuan Wang1
1Department of Hematology, The First Affiliated Hospital of Nanchang University; Institute of Hematology, Academy of Clinical Medicine of Jiangxi Province; Institute of Lymphoma of Nanchang University, Nanchang 330006, Jiangxi Province, China.
Objective:
To investigate the efficacy and safety of combination regimen containing daratumumab in multiple myeloma (MM) patients.
Methods:
The clinical data of 14 newly diagnosed MM patients and 58 relapsed refractory MM patients treated with combination regimen containing daratumumab from November 2020 to March 2023 in the First Affiliated Hospital of Nanchang University were retrospectively analyzed. The efficacy and safety of combination regimen were analyzed.
Results:
The median age of the 72 patients was 62 (38-78) years, including 35 males and 37 females. The overall response rate (ORR) of patients receiving first-line, second-line, and third-line or above treatment was 92.9% (13/14), 68.2% (30/44), and 42.9% (6/14), respectively. The median progression-free survival (PFS) was not reached, 15.4 months, and 9.7 months in three groups, respectively (all P <0.05), while the median overall survival (OS) was all not reached. Among relapsed refractory patients, the ORR of those treated with DVd, DPd and DRd regimen was 50.0% (12/24), 40.0% (4/10) and 100% (10/10), the median PFS was 2.8 months, 10.3 months and not reached, and the median OS was 15.4 months, not reached and not reached, respectively. Furthermore, the PFS and OS in the DRd group were superior to those in the other two groups (all P <0.05). Cox univariate and multivariate analysis showed that lactate dehydrogenase (LDH) ≥250 U/L and extramedullary disease were independent adverse prognostic factors for PFS, and LDH ≥250 U/L was also an independent adverse prognostic factor for OS. Hematologic adverse reactions were mainly lymphopenia (87.5%) and thrombocytopenia (52.8%), while non-hematologic adverse reactions were mainly infusion-related reactions (19.4%) and infections (11.1%).
Conclusions:
The combination regimens containing daratumumab can be used as first-line treatment for patients with newly diagnosed MM. In patients with relapsed refractory MM, early use of regimens containing daratumumab may improve treatment response rate and prolong PFS. The DRd regimen has better therapeutic response and survival advantages. LDH is an independent prognostic factor affecting PFS and OS in MM patients.
Insights
Combination daratumumab regimens show high efficacy in multiple myeloma (MM). The DRd regimen offers superior response and survival benefits, particularly in relapsed refractory MM. Lactate dehydrogenase levels are key prognostic factors.
Area of Science:
- Hematology
- Oncology
- Immunotherapy
Context:
- Multiple myeloma (MM) is a hematologic malignancy characterized by uncontrolled plasma cell proliferation.
- Standard treatments for MM include chemotherapy, immunotherapy, and stem cell transplantation.
- Daratumumab, a monoclonal antibody, has emerged as a significant therapeutic agent in MM treatment.
Purpose:
- To evaluate the efficacy and safety of combination regimens incorporating daratumumab in patients with multiple myeloma.
- To compare treatment outcomes across different daratumumab-based regimens in relapsed refractory MM.
- To identify prognostic factors influencing progression-free survival (PFS) and overall survival (OS) in MM patients treated with daratumumab.
Summary:
- Retrospective analysis of 72 MM patients (14 newly diagnosed, 58 relapsed refractory) treated with daratumumab-containing regimens.
- High overall response rates (ORR) were observed, especially in first-line treatment (92.9%).
- The DRd regimen demonstrated superior PFS and OS compared to DVd and DPd in relapsed refractory MM.
- Lactate dehydrogenase (LDH) levels and extramedullary disease were identified as independent adverse prognostic factors for PFS and OS.
Impact:
- Combination daratumumab regimens are effective as first-line therapy for newly diagnosed MM.
- Early use of daratumumab in relapsed refractory MM may enhance treatment response and prolong PFS.
- The DRd regimen shows promising therapeutic advantages, supporting its consideration in MM treatment strategies.
- Identifying LDH as a prognostic factor can aid in risk stratification and personalized treatment planning for MM patients.
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