Dr. Chari on Quadruplet Regimens in Transplant-Eligible Multiple Myeloma

Ajai Chari, MD, associate professor, hematology and medical oncology, Mount Sinai Hospital, discusses implementing quadruplet regimens in transplant-eligible multiple myeloma.

The phase III CASSIOPEIA trial demonstrated an improved progression-free survival (PFS) at a median follow-up of 18.8 months, as well as deep responses, with the addition of daratumumab (Darzalex) to bortezomib (Velcade), thalidomide (Thalomid), and dexamethasone (VTd) in newly diagnosed patients. As such, the FDA approved daratumumab plus VTd in September 2019.

Similarly, the phase I/II GRIFFIN study suggested that quadruplet therapy with daratumumab plus lenalidomide (Revlimid), bortezomib, and dexamethasone (RVd) may improve depth of the response compared with RVd alone; however, survival data are pending, explains Chari.

Following frontline quadruplet therapy and autologous stem cell transplant, maintenance therapy with lenalidomide is suggested, concludes Chari.

Lenalidomide in combination with daratumumab as maintenance therapy will be explored in an upcoming phase III clinical trial called AURIGA (NCT03901963) to potentially extend remission duration for this patient population who have minimal residual disease positivity after transplant.