Prerna Mewawalla, MD, a hematologist at Allegheny Health Network, discusses how her approaches to patients with newly diagnosed multiple myeloma have changed recently based on clinical trial outcomes.
Prerna Mewawalla, MD, a hematologist at Allegheny Health Network, discusses how her approaches to patients with newly diagnosed multiple myeloma have changed recently.
She says that for newly diagnosed, transplant-eligible patients, she now uses frontline quadruplet therapies such as Dara-RVd (daratumumab [Darzalex], lenalidomide [Revlimid], bortezomib [Velcade], and dexamethasone) if they are younger or have high-risk disease. Quadruplet therapies with the addition of an anti-CD38 monoclonal antibody have been shown to achieve a deeper response and better progression-free survival (PFS). Based on the DETERMINATION trial (NCT01208662), which showed a median PFS of 18 months, these patients should receive an autologous stem cell transplant after 4 to 6 cycles of quadruplet therapy.
For transplant-ineligible patients, Mewawalla says she uses DRd (daratumumab, lenalidomide, and dexamethasone) based on the MAIA study (NCT02252172). She feels her patients are responding well to this regimen; additionally, it only needs to be given monthly after thesixth 28-day cycle.
According to Mewawalla, results from the SWOG S2209 study (NCT05561387) comparing RVd-lite (modified lenalidomide, bortezomib, and dexamethasone) with DRd could show which regimen is most effective in the transplant-ineligible setting, offering another option for these patients.
0:08 | For a newly diagnosed patient who is transplant eligible, I have started using the quadruple treatments like Dara-RVd in the high-risk population, as well as in my younger patients who we want to achieve a deeper response and have a higher PFS. I'm also transplanting these patients after 4 to 6 cycles based on the DETERMINATION trial and having the PFS of 18 months by doing the transplant.
0:35 | For my newly diagnosed transplant-ineligible patients, I now use DRd upfront in these patients, per the MAIA study. My patients are doing well on it, and they tolerate it extremely well. The [daratumumab] addition has been great. With time, it becomes once a month, so patients like getting it as well.
I am looking forward to data from the SWOG [S2209] study, which is going to compare DRd to RVd-lite and see if that would be another option for these transplant-ineligible patients upfront. That is something I am looking forward [to].