MM-082 Addition of Daratumumab to Drug Regimens in the Treatment of Multiple Myeloma: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Publication Date

10-1-2022

Document Type

Article

Publication Title

Clinical Lymphoma, Myeloma and Leukemia

Abstract

Context: Despite improvement in the treatment of multiple myeloma (MM), a significant number of patients do not respond to the existing drug regimens. Objective: In this meta-analysis, we will assess the efficacy of daratumumab in combination with other drug regimens used in the treatment of MM. Design: Meta-analysis. Methods: A literature search was performed on PubMed, Embase, Web of Science, Cochrane, and clinicaltrials.gov with Mesh and Emtree terms, “daratumumab” and “multiple myeloma,” from the inception of data to 27 March 2022. R software was used to conduct the meta-analysis. Interventions: Daratumumab versus control. Main Outcome Measures: Pooled hazard ratio (HR) of progression-free survival (PFS), relative risk (RR) of overall response (OR), and RR of complete response (CR). Results: A total of 4,564 articles were screened, and 9 randomized clinical trials (RCTs, N=4,725) were included. All patients were adults (>18 years). Daratumumab was given to 2,481 patients in combination with regimens including lenalidomide + dexamethasone (N=649), pomalidomide + dexamethasone (N=151), bortezomib + dexamethasone (N=377), bortezomib + melphalan + prednisone (N=350), bortezomib + thalidomide + dexamethasone (N=543), carfilzomib + dexamethasone (N=312), and lenalidomide + bortezomib + dexamethasone (N=99), whereas no daratumumab was given to 2,244 patients. In relapsed/refractory multiple myeloma (RRMM) patients (N=2,001), RR of OR was 1.25 (95% CI=1.17–1.32, I2=32%), CR was 2.46 (95% CI=2.02–3, I2=31%), and HR of PFS was 0.59 (95% CI=0.50–0.69, I2=70%), all in favor of daratumumab versus the control. In stem cell transplant (SCT)-eligible patients (N=1,281), RR of OR was 1.05 (95% CI=1–1.09, I2=33%), CR was 1.4 (95% CI=1.16–1.69, I2=32%), and HR of PFS was 0.58 (95% CI=0.49–0.69, I2=0%), all in favor of daratumumab versus the control as induction and consolidation therapy. In SCT-ineligible patients (N=1,443), RR of OR was 1.18 (95% CI=1.10–1.27, I2=61%), CR was 1.86 (95% CI=1.6–2.15, I2=0%), and HR of PFS was 0.59 (95% CI=0.52–0.68, I2=61%), all in favor of daratumumab versus the control as first therapy. Conclusions: The addition of daratumumab to current regimens significantly improved PFS and response rates in patients with RRMM, SCT-eligible MM, or SCT-ineligible MM. More RCTs are needed to confirm these results.

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