Effectiveness of daratumumab plus bortezomib, lenalidomide, and dexamethasone (DVRd) versus VRd for transplant-eligible newly diagnosed multiple myeloma

Background Frontline (1L) treatment for transplant-eligible (TE) newly diagnosed multiple myeloma (NDMM) has shifted from triplet (e.g. bortezomib [V], lenalidomide [R], dexamethasone [d]) to quadruplet (e.g. daratumumab with VRd [DVRd]) regimens, based on improved efficacy demonstrated in pivotal trials. This real-world study compared progression-free survival (PFS) in TE patients with NDMM treated with DVRd plus DR or R maintenance (DVRd-DR/R) versus VRd plus R maintenance (VRd-R).Methods Adult TE patients with NDMM who initiated DVRd-DR/R or VRd-R between 1 January 2020 and 30 June 2022 were identified through a retrospective chart review at 10 US sites. PFS was assessed using Kaplan-Meier analyses and propensity score-weighted hazard ratios (HR) were estimated using Cox regression.Results Overall, 137 patients received DVRd-DR/R and 86 received VRd-R. Over a median follow-up of 26.7 and 39.8 months among the DVRd-DR/R and VRd-R cohorts, respectively, 11 (9.1%) and 32 (29.7%) patients experienced disease progression or death. Median PFS was not reached in either cohort. DVRd-DR/R versus VRd-R was associated with 63% lower risk of disease progression or death (weighted HR: 0.37, 95% confidence interval: 0.17-0.80, p = 0.006).Conclusion Findings aligned with pivotal trials, demonstrating the significant PFS benefit of 1L DVRd over VRd and supporting its real-world use for TE NDMM.