Daratumumab-Based Combination Therapy for Newly Diagnosed Multiple Myeloma
Posted: Thursday, February 20, 2020
According to results presented at the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 864) and published in the journal Blood, the combination therapy of daratumumab, ixazomib, lenalidomide, and modified-dose dexamethasone appears to be well tolerated, with activity demonstrated in patients with newly diagnosed multiple myeloma. In addition, Prashant Kapoor, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues reported that the combination treatment did not seem to impact stem cell mobilization.
In this phase II trial, investigators enrolled 40 patients with newly diagnosed multiple myeloma, measurable disease, and adequate organ function. Patients were treated with daratumumab followed by ixazomib, lenalidomide, and dexamethasone—the latter administered intravenously and then solely as a prophylactic premedication for daratumumab-associated infusion reactions. The median age of patients at enrollment was 64.5 years, and eight patients were considered to be at high risk by fluorescence in situ hybridization analysis.
For the patients who received at least two cycles of therapy, 88% achieved at least a partial response, and 33% reported a very good partial response. A total of 29 patients completed at least four cycles of treatment, and 52% reported a very good partial response. The overall best confirmed response among all patients was 95%, with 10% stringent complete response, 5% complete response, and 23% near-complete response. Stem cell collection was completed in 17 patients, with all requiring filgrastim and plerixafor.
In total, 224 cycles of treatment were administered across the patient population, with dose reductions or holds required for ixazomib (in 10% of patients), lenalidomide (20%), daratumumab (0%), and dexamethasone (13%). Among the patients, 40% demonstrated a grade 3 or higher adverse event, including hematologic (30%) and nonhematologic (18%) toxicity.
Disclosure: For full disclosure of the study authors, visit ashpublications.org.
