Insights Concerning the Use of VRd versus Rd in Patients with NDMM


Dr Alsina describes key findings from the post-hoc analysis of the SWOG S0777 trial and explains how they inform treatment strategies for elderly patients.

Case: A 77-Year-Old Man with Transplant-Not Preferred Newly Diagnosed Multiple Myeloma (NDMM)

Patient KR is a 77 y/o man.

  • PMH: T2DM, hypertension, and COPD
  • SMH: Does not smoke; drinks occasionally in social settings.

Clinical Presentation:

  • In January 2023, KR visited his PCP for his annual checkup. He reported having persistent bone pain and increased fatigue.

Clinical Workup and Diagnosis:

  • Calcium 12.5 mg/dL
  • CrCl, 40 mL/min
  • Hgb, 9.8 g/dL
  • β-2 microglobulin, 7.8 mg/L
  • Albumin, 3.4 g/dL
  • LDH wnl
  • sFLC lambda at diagnosis, 1700 mg/L
  • Bone marrow showed 40% clonal plasma cells LLC restricted-Clonose Id obtained.
  • del(17p) abnormality detected by FISH.
  • PET-CT showed osteolytic lesions in several ribs; no extramedullary disease (EMD).
  • ECOG PS 2
  • IMWG Frailty Status: Intermediate-Frail
  • KR was diagnosed with ISS III/R-ISS stage III lambda LC multiple myeloma; determined to be transplant-not preferred based on age and comorbidities.

Current Treatment:

  • After discussions with his family and clinical team, KR was initiated on Daratumumab/lenalidomide/dexamethasone (D-Rd).
  • Patient achieved complete response (CR).
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