Ranking First–Line Treatment Regimens For Transplant–Ineligible Multiple Myeloma

According to Szabolcs Kiss, MD, and colleagues, the most optimal first–line treatment regimen for patients with newly diagnosed, transplant–ineligible multiple myeloma (MM) is unclear, despite major advances in therapy options in recent decades. As such, they evaluated 34 regimens and concluded that regimens containing daratumumab appeared to increase progression–free survival (PFS) and could become the preference for first–line treatment of patients with transplant–ineligible MM. Their full rankings were published in Critical Reviews in Oncology/Hematology.


“Choosing the best treatment is difficult due to the ever–growing arsenal of treatment regimens,” Dr. Kiss detailed. He posited that the study provided clinical experts with more scientific evidence, and also highlighted the potential benefits of incorporating novel therapeutic agents into existing treatment plans.


The Bayesian network meta–analysis comprised 37 articles, encompassing 16,681 total patients. The primary outcomes of interest were risk ratios (RR) for PFS and overall survival (OS). Prospective treatments were ranked based on surface under cumulative ranking curve values.


According to the report, the regimens of daratumumab-bortezomib-melphalan-prednisone (Dara-VMP) and daratumumab-lenalidomide-dexamethasone (Dara-Rd28) were superior to other treatment regimens in terms of 12–, 24–, 36–, and 48–month PFS. Additionally, Dara-VMP was the highest rated treatment regimen for 12–, 24–, 36–, and 48–month OS.


For future practice, Dr. Kiss stated that “continuous update of the standard of care regimens is essential.” In closing, the authors reported that comparative studies between the most widely used treatment regimens and novel agent combination regimens, such as Dara-VMP, have not been conducted, but are warranted for patients with MM who are ineligible for transplantation. To guide future investigators, Dr. Kiss and colleagues suggested that “the addition of cost-effectiveness as an endpoint would further help the clinician in choosing the most beneficial regimen.”