Daratumumab, Lenalidomide and Dexamethasone Clinically Beneficial for Frail Patients With Multiple Myeloma - MD Magazine

A operation therapy of daratumumab, lenalidomide and dexamethasone (D-Rd) led to a objective effect for frail patients with recently diagnosed multiple myeloma.

A team, led by Aurore Perrot, MD, PhD, Centre Hospitalier Universitaire de Toulouse, Service d'Hématologie, assessed patient-reported outcomes successful frail patients successful information presented during the 2022 American Society of Hematology (ASH) Annual Meeting.

MAIA Trial

In a erstwhile investigation of the MAIA trial, investigators found daratumumab, lenalidomide and dexamethasone (D-Rd) improved progression-free endurance (PFS) successful transplant-ineligible patients with recently diagnosed aggregate myeloma (NDMM) compared to conscionable Revlimid and dexamethasone (Rd).

This payment continued passim a longer follow-up with a median of 56.2 months, showing an wide endurance benefit, deeper response, and meaningful improvements successful patient-reported outcomes.

The median property of patients was 73 years and 43.6% of the diligent colonisation was aged astatine slightest 75 years.

The survey besides included a frailty subgroup investigation with a median property of 77 years. Here, the investigators recovered D-Rd showed deeper responses and PFS payment comparted to Rd (not reached [NR] vs 30.4 months; HR, 0.62; P = 0.003) successful frail patients astatine a median follow-up of 36.4 months.

However, determination is small known astir health-related prime of beingness outcomes successful elderly, frail patients.

In the study, the investigators randomized 737 patients to D-Rd oregon Rd until illness progression oregon unacceptable toxicity and assessed frailty utilizing age, Charlson Comorbidity Index, and baseline Eastern Cooperative Oncology Group show presumption score.

They past categorized the patients into frail oregon non-frail subgroups and assessed patient-reported outcomes utilizing the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30-item (EORTC QLQ-C30).

Each subordinate completed the questionnaires astatine baseline, connected time 1 of cycles 3, 6, 9, and 12 for twelvemonth 1, and each 6 months until illness progression.

The investigators defined meaningful thresholds for betterment and worsening arsenic a priori based connected published lit (≥10-point change) and assessed attraction effect by a mixed-effects exemplary for repeated measures.

Subgroup Analysis

Overall, determination were patients successful the frail radical (D-Rd, n = 172; Rd, n = 169,) with a median follow-up of 64.5 months. Patients successful the frail radical treated with D-Rd reported greater improvements from baseline compared to the Rd radical successful Rd successful EORTC QLQ-C30 Global Health Status (GHS) scores and carnal functioning (LS mean alteration from baseline for D-Rd astatine Cyc 12, 12.7 vs Rd, 9.8) astatine respective clip points.

In addition, 39% of patients treated with D-Rd stayed connected attraction with patient-reported result appraisal astatine rhythm 48 compared to 17% successful the Rd group.

Additionally, patients treated with D-Rd had notably ample reductions (≥20-point change) successful symptom symptoms implicit clip and larger than that seen successful patients treated with Rd.

The investigators did observe meaningful changes from baseline successful fatigue symptoms for either attraction group.

The results for affectional functioning, societal functioning, and nausea and vomiting besides numerically favored D-Rd astatine respective clip points.

Moreover, the median clip to archetypal betterment was numerically shorter with D-Rd compared to Rd for GHS (D-Rd, 2.38 months vs Rd, 4.67 months), carnal functioning (2.60 months vs 4.65 months), symptom (2.07 months vs 2.83 months), and fatigue symptoms (2.04 months vs 3.09 months).

The median clip to archetypal worsening was longest for carnal functioning (D-Rd, 68.14 period vs Rd, 39.62 months; HR, 0.66; 95%CI, 0.45–0.95; P = 0.023) and symptom symptoms (D-Rd: NR vs Rd, 60.48 months; HR, 0.66; 95% CI, 0.44–1.00; P = 0.045), portion the median clip to archetypal worsening was longer with D-Rd vs Rd for GHS (D-Rd: 29.31 months vs Rd: 21.62 months; HR, 0.91; 95% CI, 0.65–1.26).

Finally, the median clip to archetypal worsening for the different functional, including emotional, social, relation and symptom, including nausea and vomiting, scales numerically favored D-Rd vs Rd, but cognitive functioning and fatigue.

“D-Rd demonstrates objective payment successful each patients, including frail patients,” the authors wrote. “In addition, frail patients treated with D-Rd reported sustained improvements successful planetary wellness (overall HRQoL) and carnal functioning, with notable simplification successful symptom done the duration of therapy. Additionally, higher percent of frail patients continued connected D-Rd vs Rd. D-Rd regimen is not lone clinically effectual but besides results successful a sustained betterment successful HRQoL for TIE frail pts with NDMM.”

The study, “Health-Related Quality of Life for Frail Transplant-Ineligible Patients with Newly Diagnosed Multiple Myeloma Treated with Daratumumab, Lenalidomide and Dexamethasone: Subgroup Analysis of MAIA Trial,” was published online by ASH 2022.