In a nutshell
This study assessed whether the addition of daratumumab (Darzalex) to VTd (bortezomib, thalidomide, dexamethasone) therapy could improve response in patients with multiple myeloma (MM). The authors concluded that the addition of daratumumab improved the outcomes of these patients.
Some background
Autologous stem cell transplantation (ASCT) is used as a part of MM treatment. Before the transplant, healthy stem cells are collected from the patient's bloodstream. Chemotherapy is then given to get rid of any remaining cancer cells. Then, the collected healthy cells are given back to the patient to help the body produce new healthy blood cells. Therapy may also be given before transplant, this is known as induction.
VTd is a standard induction regimen in MM. Daratumumab is a human antibody used as a drug. It works by stimulating the immune system to recognize and kill cancer cells. Studies have shown that adding daratumumab to drugs such as dexamethasone in patients improved their outcomes. It is not known if the addition of daratumumab to the VTd regimen (D-VTd) may also improve patient outcomes in these patients.
Methods & findings
This study included 1085 people with newly diagnosed MM who were suitable for stem cell transplant. Participants were divided into two groups. One group was assigned to VTd therapy. The other group received D-VTd therapy. The assigned therapy was given before and after ASCT (4 cycles before and 2 cycles after). Patients were followed-up for an average of 18.8 months.
100 days after transplant, 39% of the D-VTd group achieved a complete response or better (no cancer cells left) compared to 26% in the VTd group. Patients were tested for minimal residual disease (a small number of remaining cancer cells left after treatment). 64% of the D-VTd group and 44% of the VTd group were negative for remaining disease.
The D-VTd group had a 53% better chance of surviving without cancer returning compared to the VTd alone group.
4% of the D-VTd group and 6% of the VTd group stopped treatment due to side effects. The most common serious side effects were neutropenia (low white blood cells that fight infection; 28% for D-VTd and 15% for VTd), lymphopenia (low white blood cells involved in immunity; 17% for D-VTd and 10% for VTd), and inflammation of the gums (13% for D-VTd and 16% for VTd).
The bottom line
The authors found that D-VTd before and after ASCT improved responses in patients with MM.
The fine print
Not all patients completed chemotherapy and/or stem cell transplant. This might have influenced the results.
Published By :
Lancet (London, England)
Date :
Jun 03, 2019
