Dr. Chari on the Use of Frontline Daratumumab in Transplant-Eligible Patients With Myeloma

Ajai Chari, MD, associate professor, hematology and medical oncology, Mount Sinai Hospital, discusses the use of frontline daratumumab (Darzalex) in transplant-eligible patients with multiple myeloma.

Historically, transplant-eligible patients have been treated with bortezomib (Velcade), lenalidomide (Revlimid) and dexamethasone, says Chari. However, trials are now examining whether quadruplet regimens may be more effective than triplets.

The phase III CASSIOPEIA study showed that the primary endpoint of stringent complete response (sCR) increased from 20% in the control arm to 29% with the addition of daratumumab to bortezomib, thalidomide (Thalomid), and dexamethasone. At a follow-up of 18 months, there was a significant improvement in progression-free survival (PFS) with the addition of daratumumab and minimal additive toxicities, says Chari. Notably, there was a slight decrease in stem cell yield, but this did not detract from the compelling PFS and sCR results, he explains.

Additionally, the phase II GRIFFIN study randomized patients in the United States to receive lenalidomide, bortezomib, and dexamethasone with or without daratumumab. Similarly, investigators reported that the sCR and minimal residual disease negativity rates were improved with the addition of daratumumab. These results support that quadruplet therapy might be where the field is headed in terms of consolidation with transplant. However, the IFM 2009 study speaks for itself, with a higher PFS relative to not receiving a transplant, concludes Chari.