D-VRd Improves MRD Negativity Versus VRd in PERSEUS Myeloma Trial

By Patrick Daly - Last Updated: September 13, 2024

Among patients with transplant-eligible, newly-diagnosed multiple myeloma, the addition of daratumumab to VRd induction and consolidation (D-VRd)—and to subsequent lenalidomide maintenance (D-R)—induced higher rates of measurable residual disease (MRD) negativity, according to an analysis of the phase III PERSEUS study.

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The analysis was led by Pieter Sonneveld, MD, PhD, of the Erasmus MC Cancer Institute. Meletios Dimopoulos, MD, of the National and Kapodistrian University of Athens, presented the data at the Society of Hematologic Oncology 2024 Annual Meeting.

The PERSEUS trial randomized 709 patients to either D-VRd (n=355) or VRd (n=354). The primary analysis showed that D-VRd followed by D-R improved progression-free survival (PFS) and depth of response compared with VRd followed by R.

In this follow-up analysis, MRD negativity was evaluated in patients in the intention-to-treat population who achieved a complete response (CR) or better. The researchers reported the following CR and MRD outcomes per group:

Outcome D-VRd VRd
CR or better rate
·        End of consolidation 44.5% 34.7% (P=.0078)
·        Overall 87.9% 70.1% (P<.0001)
MRD negativity (10-6) rate
·        12 months 43.9% 20.9% (P<.0001)
·        24 months 57.7% 27.4% (P<.0001)
·        36 months 63.9% 30.8% (P<.0001)
MRD negativity for 12 or more months 47.3% 18.6% (P<.0001)

 

Additionally, of patients who did not achieve MRD negativity during consolidation, 56.7% in the D-VRd versus 25.2% in the VRd group (P<.0001) achieved MRD negativity during maintenance. The rate of sustained MRD negativity for 12 or more months was 31.3% with D-VRd versus 10.3% with VRd (P<.0002).

The authors noted that MRD at the end of consolidation and overall was associated with improved PFS.

“These data support D-VRd and D-R maintenance as a new standard of care for transplant-eligible, newly-diagnosed multiple myeloma and highlight the benefit of daratumumab in maintenance,” the report concluded.

Reference

Sonneveld P, Moreau P, Dimopoulos MA, et al. Daratumumab + bortezomib/lenalidomide/dexamethasone in (D-VRd) transplant eligible (TE) patients with newly diagnosed multiple myeloma (NDMM): analysis of minimal residual disease (MRD) in the phase 3 PERSEUS study. Abstract #MM-355. Presented at the Society of Hematologic Oncology 2024 Annual Meeting; September 4-7, 2024; Houston, Texas.

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