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

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Clinical Lymphoma, Myeloma and Leukemia


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 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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