Outcomes of daratumumab in the treatment of multiple myeloma: A retrospective cohort study from the Canadian Myeloma Research Group Database

Abstract

Daratumumab (dara) has significantly altered the therapeutic landscape of multiple myeloma (MM), especially in the relapsed setting. This study aimed to evaluate the outcomes of dara-containing regimens in the Canadian real-world setting among relapsed and refractory MM available within the national Canadian Myeloma Research Group Database (CMRG-DB). A total of 583 MM patients who received dara-based therapy in second-line or later treatment were included. After a median follow-up of 17.5 months, the median progression-free survival (PFS) and overall survival (OS) for the entire cohort were 13.1 and 32.9 months, respectively. The median PFS and OS were 23.5 and 49.1 months in second-line treatment and decreased to 12.8 and 43.

Beyond Clinical Trials in Patients With Multiple Myeloma: A Critical Review of Real-World Results

“…Responses were higher with Dara-Rd than with Dara-Vd and daratumumab monotherapy (ORR: 85% vs. 58% vs. 45%; ≥VGPR: 59% vs. 29% vs. 21%), thus confirming the synergistic effect of daratumumab plus lenalidomide also in clinical practice. Survival data were also more positive with Dara-Rd (median PFS of 26 months and median OS of 32 months), as compared with the other two treatment regimens ( 79 ).…”

Outcome of carfilzomib/pomalidomide‐based regimens after daratumumab‐based treatment in relapsed multiple myeloma: A Canadian Myeloma Research Group Database analysis

“…From the CMRG-DB, we initially selected 583 myeloma patients who received a daratumumab-based therapy at time of relapse (DVd n = 143, DRd/p n = 263, DPd/p n = 77, and Dd/p n = 100), as previously published. 28 After a median follow-up of 21 months from initiation of this therapy, 178 patients were still on their daratumumab-containing therapy, 116 patients died before subsequent therapy, 19 patients relapsed but did not initiate subsequent therapy, 2 patients declined subsequent therapy, and subsequent Patients who received a treatment using both IMiD and PI based on carfilzomib and/or pomalidomide had a median PFS and OS of 4.1 and 14.5 months, respectively (Table 2 and Figure 1B,C). In multivariate analysis, treatment received based on carfilzomib and/or pomalidomide was not a variable influencing significantly the outcome in terms of progression or death (data not shown).…”

“…Even high‐dose chemotherapy followed by autologous stem cell transplantation in 69 daratumumab‐refractory myeloma patients who received a median of 5 prior lines of treatment achieved a median PFS of only 7.2 months 26 . Our study specifically looked at patients who have been exposed to daratumumab in the previous line of treatment, as previously published, 28 and included 97% patients refractory to daratumumab, 97% TCE, and 60% triple‐class refractory who received a median of 3 prior lines of treatment. We focused on patients who received a subsequent line of therapy based on carfilzomib or pomalidomide since they are the usual regimens used in this population in Canada after the use of bortezomib, lenalidomide, and an anti‐CD38 monoclonal antibody 37,38 .…”

“…All patients included in this study were previously treated with a daratumumab‐based regimen used in the relapsed setting after at least one prior line of therapy. Their eligibility and selection criteria from the database in addition to their outcome on this specific line of treatment have been previously published 28 . Briefly, patients previously exposed to daratumumab‐based therapy for relapsed myeloma in our prior trial 28 were included in this present trial if they stopped their daratumumab‐based therapy for disease progression, intolerance or at the physician/patient discretion and initiated a subsequent line of treatment following disease progression.…”

“…Their eligibility and selection criteria from the database in addition to their outcome on this specific line of treatment have been previously published. 28 Briefly, patients previously exposed to daratumumab-based therapy for relapsed myeloma in our prior trial 28 were included in this present trial if they stopped their daratumumab-based therapy for disease progression, intolerance or at the physician/patient discretion and initiated a subsequent line of treatment following disease progression. Subsequent line of therapy had to be based on carfilzomib and/or pomalidomide.…”