Comparing the effectiveness of combined therapy of bortezomib, melphalan, and prednisone with versus without daratumumab in patients with multiple myeloma ineligible for a transplant

The study evaluated the effectiveness of combined therapy of bortezomib (Velcade), melphalan (Alkeran), and prednisone (Deltasone) with (D-VMP) versus without (VMP) daratumumab (Darzalex) in transplant-ineligible patients newly diagnosed with multiple myeloma (MM). The study concluded that D-VMP was more effective than using VMP alone in patients with newly diagnosed MM and ineligible for a transplant.

Multiple myeloma (MM) is a cancer of the blood that begins in the plasma cells. Treatments of MM include chemotherapy, immunotherapy, radiotherapy, targeted therapy, corticosteroids, and bone marrow transplants. However, not everyone is eligible for a bone marrow transplant. Therefore, different therapies are being explored such as combined therapies.

Daratumumab is an immunotherapy drug that directly kills the tumor cells. Daratumumab has been shown to be effective both as a monotherapy or combined therapy in relapsed or refractory MM or newly diagnosed MM.

VMP combined therapy is known to be an effective therapy for newly diagnosed MM who are not eligible for bone marrow transplant. Additionally, previous studies have found that D-VMP was effective and showed better chances of being free from the progression of the disease after treatment compared to VMP alone. However, the use of D-VMP has not been studied in transplant-ineligible Asian patients with newly diagnosed MM.

The study included 220 patients with newly diagnosed MM and ineligible for transplant. The subjects were randomly assigned to either D-VMP or VMP alone. 9 cycles of VMP were received. Daratumumab was given intravenously weekly in cycle 1, every 3 weeks in cycles 2 to 9, and every 4 weeks thereafter for the D-VMP group. The average follow-up was 12.3 months.

Patients in the D-VMP group had a 53% higher progression-free survival compared to the VMP alone group. After 1 year, 84.2% in the D-VMP group were alive without disease progression compared to 64.6% in the VMP alone group.

The most common side effects of D-VMP and VMP were low platetels (blood cells involved in clotting), and low white blood cell counts. The infection rate (66.7%) was higher in the D-VMP group compared to the VMP group (50.7%).

The study concluded that D-VMP was more effective than VMP in Asian patients with newly diagnosed MM and ineligible for transplant.

This study had a short follow-up study and only included Asian patients. Larger studies are needed. This study was funded by Jansen, the manufacturer of daratumumab.