University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France.
Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK.
Leukemia. 2022 Apr;36(4):1066-1077. doi: 10.1038/s41375-021-01488-8. Epub 2022 Jan 2.
In the phase 3 MAIA study of patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab plus lenalidomide/dexamethasone (D-Rd) improved progression-free survival (PFS) versus lenalidomide/dexamethasone (Rd). We present a subgroup analysis of MAIA by frailty status. Frailty assessment was performed retrospectively using age, Charlson comorbidity index, and baseline Eastern Cooperative Oncology Group performance status score. Patients were classified as fit, intermediate, non-frail (fit + intermediate), or frail. Of the randomized patients (D-Rd, n = 368; Rd, n = 369), 396 patients were non-frail (D-Rd, 196 [53.3%]; Rd, 200 [54.2%]) and 341 patients were frail (172 [46.7%]; 169 [45.8%]). After a 36.4-month median follow-up, non-frail patients had longer PFS than frail patients, but the PFS benefit of D-Rd versus Rd was maintained across subgroups: non-frail (median, not reached [NR] vs 41.7 months; hazard ratio [HR], 0.48; P < 0.0001) and frail (NR vs 30.4 months; HR, 0.62; P = 0.003). Improved rates of complete response or better and minimal residual disease (10) negativity were observed for D-Rd across subgroups. The most common grade 3/4 treatment-emergent adverse event in non-frail and frail patients was neutropenia (non-frail, 45.4% [D-Rd] and 37.2% [Rd]; frail, 57.7% and 33.1%). These findings support the clinical benefit of D-Rd in transplant-ineligible NDMM patients enrolled in MAIA, regardless of frailty status.
在不适合移植的新诊断多发性骨髓瘤(NDMM)患者的 3 期 MAIA 研究中,与 lenalidomide/dexamethasone(Rd)相比,daratumumab 联合 lenalidomide/dexamethasone(D-Rd)改善了无进展生存期(PFS)。我们根据虚弱状态对 MAIA 进行了亚组分析。虚弱评估是通过年龄、Charlson 合并症指数和基线东部合作肿瘤学组表现状态评分回顾性进行的。患者被分为健康、中度虚弱、非虚弱(健康+中度虚弱)或虚弱。在随机分组的患者(D-Rd,n=368;Rd,n=369)中,396 例患者为非虚弱(D-Rd,196 [53.3%];Rd,200 [54.2%]),341 例患者为虚弱(172 [46.7%];169 [45.8%])。中位随访 36.4 个月后,非虚弱患者的 PFS 长于虚弱患者,但 D-Rd 与 Rd 相比 PFS 获益在各亚组中得以维持:非虚弱(中位,未达到[NR]vs41.7 个月;风险比[HR],0.48;P<0.0001)和虚弱(NR vs30.4 个月;HR,0.62;P=0.003)。在各亚组中,D-Rd 观察到完全缓解或更好和微小残留疾病(10)阴性率提高。非虚弱和虚弱患者中最常见的 3/4 级治疗相关不良事件是中性粒细胞减少症(非虚弱,45.4%[D-Rd]和 37.2%[Rd];虚弱,57.7%和 33.1%)。这些发现支持在 MAIA 中招募的不适合移植的 NDMM 患者中使用 D-Rd 的临床获益,无论虚弱状态如何。
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