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Facon, Thierry; Cook, Gordon; Usmani, Saad Z; Hulin, Cyrille; Kumar, Shaji; Plesner, Torben; Touzeau, Cyrille; Bahlis, Nizar J; Basu, Supratik; Nahi, Hareth; Goldschmidt, Hartmut; Quach, Hang; Mohty, Mohamad; Venner, Christopher P; Weisel, Katja; Raje, Noopur; Hebraud, Benjamin; Belhadj-Merzoug, Karim; Benboubker, Lotfi; Decaux, Olivier; Manier, Salomon; Caillot, Denis; Ukropec, Jon; Pei, Huiling; Van Rampelbergh, Rian; Uhlar, Clarissa M; Kobos, Rachel; Zweegman, Sonja
Leukemia, 04/2022, Volume: 36, Issue: 4Journal Article
In the phase 3 MAIA study of patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab plus lenalidomide/dexamethasone (D-Rd) improved progression-free survival (PFS) versus lenalidomide/dexamethasone (Rd). We present a subgroup analysis of MAIA by frailty status. Frailty assessment was performed retrospectively using age, Charlson comorbidity index, and baseline Eastern Cooperative Oncology Group performance status score. Patients were classified as fit, intermediate, non-frail (fit + intermediate), or frail. Of the randomized patients (D-Rd, n = 368; Rd, n = 369), 396 patients were non-frail (D-Rd, 196 53.3%; Rd, 200 54.2%) and 341 patients were frail (172 46.7%; 169 45.8%). After a 36.4-month median follow-up, non-frail patients had longer PFS than frail patients, but the PFS benefit of D-Rd versus Rd was maintained across subgroups: non-frail (median, not reached NR vs 41.7 months; hazard ratio HR, 0.48; P < 0.0001) and frail (NR vs 30.4 months; HR, 0.62; P = 0.003). Improved rates of complete response or better and minimal residual disease (10 ) negativity were observed for D-Rd across subgroups. The most common grade 3/4 treatment-emergent adverse event in non-frail and frail patients was neutropenia (non-frail, 45.4% D-Rd and 37.2% Rd; frail, 57.7% and 33.1%). These findings support the clinical benefit of D-Rd in transplant-ineligible NDMM patients enrolled in MAIA, regardless of frailty status.
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