Background: Daratumumab in combined with bortezomib, lenalidomide and dexamethasone (DVRD) or carfilzomib, lenalidomide and dexamethasone (KRD) has been recommended as first-line induction regimen in patients with newly diagnosed multiple myeloma (NDMM). However, the superiority of these two regimens remains unknown. Given the lack of head-to-head clinical trials, this study systematically reviewed the clinical studies regarding DVRD and RVD regimen in the treatment of NDMM to explore the better choose of the first-line therapy.

Methods: We searched in the Cochrane Library, PubMed, Embase, and Web of Science databases to collect studies containing DVRD or KRD for NDMM, then we performed pooled and meta-analysis to compare overall response rate (ORR), complete remission(CR) rate, stringent complete remission (sCR) rate, minimal residual disease (MRD)-negative status, progression-free survival (PFS), overall survival (OS) and treatment-related discontinuation rate, grade 3-4 adverse events rate between DVRD and KRD regimen by using R 4.3.3 software.

Results: Of 3570 studies screened, 6 randomized controlled trial and 8 single-arm clinical trial were eligible including 483 patients treated with DVRD and 1509 treated with KRD. We found a statistically non-significant difference in therapeutic response including ORR, CR, sCR and MRD-negative status between DVRD and KRD regimen. Compared to KRD regimen, patients treated with DVRD were associated with improved PFS (not reached vs. 58.24 months, pool HR 0.41; 95%CI 0.32-0.53) and OS (both were not reached, pool HR 0.64, 95%CI 0.45-0.90). The grade 3-4 adverse events rate between DVRD and KRD regimen was non-significant statistical different while the therapy discontinuation rate led by adverse events was significantly lower in patients treated with DVRD than those treated with KRD (2% vs. 6%, P=0.01).

Conclusion: This meta-analysis indicated that DVRD regimen as first-line induction treatments could bring patients with NDMM with better outcomes and lower treatment-related discontinuation rate than KRD regimen.

Disclosures

No relevant conflicts of interest to declare.

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2024
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