3-WEEKLY DARATUMUMAB-IMID-DEXAMETHASONE IS HIGHLY EFFICACIOUS, HENCE FINANCIALLY AFFORDABLE WITH ENORMOUS ECONOMIC IMPACT FOR RELAPSED/REFRACTORY MULTIPLE MYELOMA IN LESS AFFLUENT COUNTRIES
Author(s): ,
Chor Sang Chim
Affiliations:
Medicine,The University of Hong Kong,Hong Kong,Hong Kong
,
Vincent Kai Chung Wong
Affiliations:
Pharmacy,Queen Mary Hospital,Hong Kong,Hong Kong
,
Yuen Ling Elaine Au
Affiliations:
Pathology,Queen Mary Hospital,Hong Kong,Hong Kong
Yok Lam Kwong
Affiliations:
Medicine,The University of Hong Kong,Hong Kong,Hong Kong
EHA Library. Chim C. Jun 15, 2019; 267049; PS1432
Prof. Dr. Chor Sang Chim
Prof. Dr. Chor Sang Chim
Contributions
Abstract

Abstract: PS1432

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Daratumumab  (dara) with immunomodulatory agents (IMiD) and dexamethasone (dex) is highly effective in relapsed multiple myeloma (MM). The recommended schedule of dara is weekly for 8 doses, followed by 2-weekly for 8 doses, and then every 4-weekly thereafter. Given the high cost and the long half-life as an antibody, a 3-weekly dosing of dara was used together with IMiD/dexamethasone.

Aims
Dara at 16mg/kg was used every 3-weekly with lenalidomide or pomalidomide. Patient achieving best response received single agent IMiD maintenance until disease progression.

Methods
Fourteen relapsed MM patients were enrolled. One had received weekly dara from a private oncologist, hence was excluded from analysis. Thirteen patients at a median age of 63 years (range: 50-84 years) were studied. The median number of previous therapies was 2 (range: 1-5), with nine patients (69.2%) having undergone autologous stem cell transplantation. Three patients (23.1%) were refractory to bortezomib, seven patients (53.8%) to lenalidomide, and eight patients (61.5%) to last treatment. At relapse, two (15.4%) had high LDH, eight (61.5%) impaired renal function, and three (23.1%) extramedullary disease.  Treatment was dara-lenalidomide-dex  in six (46.2%), and dara-pomalidomide-dex in seven (53.8%).

Results
Responses after four cycles included CR in 5 patients (38.5%), VGPR in five patients (38.5%), and PR in three patients (23.1%). After a median of four dara infusions (range: 3-10), the best responses included CR in seven patients (53.8%), nCR in two patients (15.4%), VGPR in two patients (15.4%), and PR in two patients (15.4%). Median time to VGPR was one month. At 10 months, the OS was 90%, and PFS 54.7%. Three patients progressed, one of whom died of ruptured hepatic plasmacytoma. The most frequent toxicity was haematological especially neutropenia (all grades: 92.3%, Grade ¾: 76.9%), infusion reaction (38.5%, all grade ½), neuropathy (38.5%, all grade ½), gastrointestinal (all grades: 38.5%, grade ¾: 7.7%), and sepsis (all grades: 30.8%; grade ¾: 23.1%). Neutropenia was effectively prevented with prophylactic G-CSF.

Conclusion
In conclusion, a 3-weekly dara-IMiD-dex regimen is highly efficacious, inducing deep and rapid responses, hence cost-effective for less affluent countries. In view of prevalent grade3/4 neutropenia despite less frequent dara, 3-weekly dara might be more suitable for Asian patients.   

Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical

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