Daratumumab + lenalidomide vs lenalidomide as myeloma maintenance | Mitul Gandhi, MD

Hi, my name is Mithil Gandhi. I'm a medical oncologist and hematologist at Virginia Cancer Specialists and I focus on malignant hematology research and immune cell therapy. I've been asked to talk about the Uriaga abstract here at ASH 2025. Uriaga is a study that was looking at patients with newly diagnosed multiple myeloma and they were given best available therapy at that time when the study was conceived. After they received that therapy they would get something called a stem cell transplant or an autologous stem cell transplant which is a established therapeutic modality and multiple myeloma where we take patient stem cells out, give them chemotherapy, and then give them back to them. This is an effort to reduce the amount of multiple myeloma in the bone marrow, an effort to improve long-term outcomes. What this particular study did was take these patients with newly diagnosed disease one or one initial chemotherapy then were consolidated with a stem cell transplant and then randomized them to two different arms. The rationale for this was that after transplantation we leave patients on a relatively low intensity what we call maintenance therapy in effort to maintain the remission they achieved after that transplant. The question that was asked on this particular trial is if we take patients who had received a transplant and we looked at their bone marrow biopsy afterwards and found what we call measurable residual disease or MRD and what that means is we found a microscopic amount of myeloma that was remaining in spite of all the therapy that had already been received and we took those patients and randomized them into two arms, one receiving the standard maintenance therapy at that time called lenalidomide or the brand name Revlimid or lenalidomide with another drug an antibody drug called daratumumab. And so again this is taking patients who have received initial therapy consolidated with a stem cell transplant after the transplant demonstrating what we call MRD or measurable residual disease positivity and then randomizing them into two arms with or without daratumumab which is an antibody and then continuing the standard maintenance therapy at that time lenalidomide. And what the trial found is when we looked at these patients over multiple time points afterwards is in the arm that got daratumumab and lenalidomide their ability to convert from MRD positive to MRD negative was significantly higher. So the arm of patients that received both drugs daratumumab and lenalidomide went from an MRD positive space to an MRD negative result more often than the patients who were on lenalidomide alone. And the reason this matters or we believe it matters is that the achievement of MRD negativity particularly at multiple different time points tends to help predict long-term survival and outcome and that's a way of saying that MRD negativity and sustained MRT negativity is a surrogate for longer term clinical outcomes. And so as a summary what this trial showed is is that by adding on this drug daratumumab to the established maintenance therapy at that time lenalidomide we are more powerfully able to convert patients from an MRD positive space to an MRD negative state and in doing so improve their long-term outcome. If our videos have helped you in any way and you're able to please consider making a donation to help us continue this important work. Your gift will go three times as far when we reach five hundred thousand dollars by the end of the year. Every contribution big or small makes a difference and we're deeply grateful for your support.