Dara-RVd lite for High Risk Smoldering Myeloma | Omar Nadeem, MD | #ASH24

Hi, my name is Omar Nadeem. I'm from the Dana-Farber Cancer Institute. Slightly different study, again, looking at different approaches in this population. As I mentioned, daratumumab is a single agent that has shown benefit versus observation. But what about combining daratumumab with the agents that we do for patients with newly diagnosed myeloma? We typically will give daratumumab revlimid Velcadexomethazone, the most commonly used front line regimen for newly diagnosed myeloma. We've been doing a trial looking at that DERA RVD regimen in patients with high-risk small green myeloma. We have modified the schedule to make it more tolerable. The doses are a bit less, the schedule is a bit less intense. This is a two-year treatment program driven by MRD. Patients that achieve MRD negativity at that two-year mark will come off. Those that are still positive will be randomized to either two more years of daratumumab and lenalidomide or will go on observation. We've been giving updates of this study over the years. We've now enrolled 45 patients to this trial as part of this last data cutoff. The majority of these patients met high-risk criteria per the either 20-20 model or had other high-risk features that have been established. And the overall response rate is 98 percent and over 60 percent of patients are in a complete response. And at the patients that have gone through the two-year mark, again, not everybody out of those 45, but those that have about 65 percent of those are MRD negative at 10 to the minus 5 to date. So and we're seeing those numbers get better and better over time. And our hope is that this will again lead to long-term remissions for these patients so they don't have to worry about development of disease. So there are two slightly different approaches. One is looking at immunotherapy. One is looking at more traditional combination therapy that we use for myeloma. And we're trying to see if we can really prevent disease and symptomatic progression in these patients with these interventions.