Summary of Final Analysis from the MASTER Trial of DARA+KRd

Case: A 54-Year-Old Woman with Newly Diagnosed Multiple Myeloma (NDMM)

Clinical Presentation:

• FH is a 54-year-old woman who presents to her physician with complaints of back pain, fatigue, nausea, constipation, and occasional, but recurring dizziness

Initial Clinical Workup and Diagnosis:

• Hb 7.0 g/dL
• Calcium 11.3 mg/dL
• Creatinine, 1.5 mg/dL
• Albumin, 3.2 g/dL
• β2-microglobulin, 6.0 mg/dL
• LDH 200 U/L
• Bone marrow biopsy showed monoclonal plasma cells, 22%.
• Serum monoclonal protein, 5.0 g/dL
• Serum kappa FLC, 240.0 mg/L
• FISH: (+) IGH Translocations; none
• ECOG PS 1
• AG was diagnosed with R-ISS stage II/R2-ISS stage III IgG-kappa myeloma.
  • CAR T eligible

Treatment:

• Patient was initiated on daratumumab/bortezomib/ lenalidomide/ dexamethasone (D-VRd) induction therapy prior to receiving ASCT, followed by lenalidomide maintenance therapy.
  • She achieved VGPR post-induction, and
  • Maintained VGPR post-ASCT

This is a video synopsis/summary of a Case-Based Peer Perspective featuring: Douglas Sborov, MD.

The phase 2 MASTER trial investigated daratumumab, carfilzomib, lenalidomide, and dexamethasone (DKRd) in transplant-eligible newly diagnosed multiple myeloma. Patients received DKRd induction, autologous stem cell transplant, then 4 cycles of DKRd consolidation. Those achieving minimal residual disease (MRD) negativity twice discontinued treatment; others completed planned DKRd.

Postconsolidation MRD-negativity rates (10-5 threshold) were approximately 80% overall and in subgroups without high-risk cytogenetics, with 1 high-risk abnormality, and with ultra–high-risk disease. MRD-negativity rates (10-6 threshold) were 66% overall but lower in the ultra–high-risk subgroup. Three-year progression-free survival was 66% without high-risk features, 82% with 1 high-risk feature, and 63% with 2 or more high-risk features.

Key conclusions: DKRd is highly effective even in high-risk newly diagnosed transplant-eligible multiple myeloma. MRD-adapted therapy should be explored further in specific populations. Patients with 2 or more high-risk cytogenetic features need improved approaches.

Video synopsis is AI-generated and reviewed by Targeted Oncology® editorial staff.