Lenalidomide and dexamethasone (Rd)-based triplets, in particular Carfilzomib-Rd (KRd) and Daratumumab-Rd (DaraRd), represent a standard of care in lenalidomide sensitive multiple myeloma (MM) patients in first relapse. Meta-analysis of randomized clinical trials (RCT), suggested better outcome with DaraRd.
Trying to address this issue in clinical practice, we collected data of 430 consecutive MM patients addressed to Rd-based triplets in first relapse between January 2017 and March 2021. Overall, the most common used regimen was DaraRd, chosen in almost half of the cases (54.4%), followed by KRd (34.6%). Different triplets were used much less commonly.
In the attempt to limit the imbalance of a retrospective analysis, we conducted a propensity score matching (PSM) comparison between DaraRd and KRd. After PSM, efficacy of DaraRd vs KRd was similar in terms of overall response rate (ORR) (OR: 0.9, p=0.685) as well as of very good partial response (VGPR) or better (OR: 0.9, p=0.582). The median progression-free survival (PFS) was significantly longer for DaraRd (29.8 vs 22.5 months; p=0.028). DaraRd was better tolerated, registering a lower rate of grade 3-4 non-hematological toxicity (OR: 0.4, p<0.001).
With the limitations of any retrospective analysis, our real-life PSM comparison between DaraRd and KRd, in first relapse MM patients, showed better tolerability and prolonged PFS of DaraRd, although with some gap of performance, in particular of DaraRd, with respect to RCT. Carfilzomib containing regimens, like KRd, still remain a valid second-line option in the emergent scenario of first line Daratumumab-based therapy.
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