P-166: Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone (DVRd) vs Daratumumab, Carfilzomib, Lenalidomide and Dexamethasone (DKRd) as Induction Therapy in Newly Diagnosed Multiple Myeloma

Introduction: DVRd and DKRd are promising induction regimens for newly diagnosed multiple myeloma (NDMM), resulting in deep responses and high minimal residual disease (MRD) negativity rates. Our prior work demonstrated PFS benefit in high-risk (HR) NDMM receiving KRd versus VRd. Herein, we examined early outcomes associated with DVRd and DKRd induction for transplant eligible patients (pts) with NDMM.

Methods: We conducted a chart review study with NDMM pts treated with DVRd (N=82) and compared outcomes with pts treated with DKRd (N=79), of which 68 were on study (NCT03290950) at our center (10/5/2017 to 12/29/22). Data cutoff for analysis was 1/31/23. Pts with
Results: Median age was 66 (IQR 59-70) for DVRd- and 59 (50-65) for DKRd-treated pts (P < 0.001). DVRd group had 68% White and 16% Black, while DKRd had 78% White and 8% Black. The majority of pts in both groups were RISS Stage 2 (DVRd RISS 1/2/3: 21%/75%/5%; D-KRd: 38%/57%/5%). With HR cytogenetics defined as 1q+, t(4;14), t(14;16), t(14;20), del(17p), 26/71 (37%) in DVRd and 38/77 (49%) in DKRd had cytogenetic results that met HR criteria (P=0.12). Median number of cycles was 6 (4-6) for DVRd and 8 (7-8) for DKRd (P < 0.001). At data cutoff, 31 (39%) DVRd- and 25 (32%) DKRd-treated pts received upfront ASCT.

Best ORR was 96% and 100% for DVRd and DKRd (P=0.2), respectively. Within C8 of tx, 61 (74%) DVRd- and 72 (91%) DKRd-treated pts achieved >/=VGPR (P=0.005). There were 2 pts with stable disease and 1 progressive disease as best response on DVRd. 62 DVRd and 72 DKRd pts had a BMBx /=CR on DVRd and DKRd, respectively. Among pts with BMBx
Conclusions: In this single center chart review, DVRd was compared to DKRd. Importantly, DKRd pts were primarily from a clinical trial, perhaps affecting demographics of the groups (DVRd group had older pts and more Black pts; DKRd group had more HR pts and received more cycles due to trial design). Best ORR was similar for both groups. Although CR rate was greater with DKRd, on multivariable analysis there was a trend toward better CR rate with DKRd vs DVRd without reaching statistical significance. Data with follow-up outcomes, including HR subgroups, will be presented at the meeting.