Comparative Efficacy of Daratumumab Based Regimens in Patients With Relapsed-Refractory Multiple Myeloma (RRMM) Aged 70 and Above: A Multicenter Study.

BACKGROUND

Patients aged ≥ 70 years with relapsed/refractory multiple myeloma (RRMM) face unique challenges due to physiological changes and increased toxicity from treatments. Daratumumab-based regimens have shown efficacy, but direct comparisons in elderly populations are lacking.

METHODS

A multicenter retrospective study compared daratumumab, pomalidomide, and dexamethasone (DPd) to daratumumab, carfilzomib, and dexamethasone (DKd) in patients with RRMM aged ≥ 70 years. The primary endpoint was progression-free survival (PFS), with secondary endpoints including overall survival (OS) and response rates.

RESULTS

The study included 150 patients (119 DPd, 31 DKd). Baseline characteristics were similar, but DPd had more lenalidomide-refractory patients (90% vs. 74%, p = 0.035). Overall response rates were comparable (DPd 77%, DKd 74.5%, p = 0.8), but DKd had a significantly higher rate of deep responses (64.5% vs. 36%, p < 0.01). Median PFS was 12 months for DPd and 13 months for DKd (p = 0.6); median OS was 50 months for DPd and 28 months for DKd (p = 0.2). Multivariate analysis identified poor performance status and high-risk cytogenetics as adverse prognostic factors.

CONCLUSION

DPd and DKd showed similar efficacy for elderly RRMM patients, with DKd achieving deeper responses. Treatment decisions should consider individual patient factors rather than focusing solely on efficacy differences.