|The following article features coverage from the American Society of Clinical Oncology 2019 meeting. Click here to read more of Hematology Advisor’s conference coverage.|
Adding daratumumab to induction and consolidation therapy for transplant-eligible patients with newly diagnosed multiple myeloma may lead to improved outcomes, according to results from part 1 of the phase 3 CASSIOPEIA trial (ClinicalTrials.gov Identifier: NCT02541383) presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Illinois.
This analysis included 1085 patients with newly diagnosed multiple myeloma who underwent autologous stem cell transplantation (ASCT). Patients were randomly assigned to receive induction and consolidation therapy with bortezomib, thalidomide, and dexamethasone (VTd) either alone (543 patients) or with daratumumab (D-VTd; 542 patients). Patients received 4 cycles of pretransplant induction therapy and 2 cycles of post-transplant consolidation therapy.
Following induction and consolidation, the researchers assessed measurable residual disease (MRD) status using multiparametric flow cytometry (MFC) with a 10-5 sensitivity threshold and next-generation sequencing with a 10-6 sensitivity threshold.
The D-VTd cohort demonstrated greater rates of MRD negativity after both induction (34.6% vs 23.1%; P <.0001) and consolidation (MFC, 63.7% vs 43.5%; NGS, 39.1% vs 22.8%; P <.0001 for both) compared with the VTd cohort. These rates were comparable between patient subgroups and showed no association with International Staging System score or cytogenetic risk.
In both treatment arms, patients who achieved MRD negativity demonstrated improved progression-free survival (hazard ratio [HR], 0.31; P <.0001), though patients in the D-VTd cohort experienced greater benefit compared with patients in the VTd cohort (HR, 0.48; P =.0028).
The researchers concluded that combining daratumumab with VTd induction and consolidation led to deepened responses and significant increases in MRD negativity rates.
1. Avet-Loiseau H, Moreau P, Attal M, et al. Efficacy of daratumumab (DARA_ + bortezomib/thalidomide/dexamethasone (D-VTd) in transplant-eligible newly diagnosed multiple myeloma (TE NDMM) based on minimal residual disease (MRD) status: Analysis of the CASSIOPEIA trial. Poster presentation at: 2019 ASCO Annual meeting; June 3, 2019; Chicago, IL. Abstract 8017.