(daratumumab and hyaluronidase-fihj)
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Last Updated: 05/08/2024
Abbreviations: CR, complete response; CrCl, creatinine clearance; d, dexamethasone; D, daratumumab; D-Pd, daratumumab + pomalidomide + dexamethasone; ECOG PS, Eastern Cooperative Oncology Group performance status; HRQoL, health-related quality of life; Ig, immunoglobulin; IgA, immunoglobulin A; IgD, immunoglobulin D; IgE, immunoglobulin E; IgG, immunoglobulin G; IgM, immunoglobulin M; ISS, International Staging System; MM, multiple myeloma; MRD, minimal residual disease; ORR, overall response rate; OS, overall survival; P, pomalidomide; Pd, pomalidomide + dexamethasone; PD, progressive disease; PFS, progression-free survival; PI, proteasome inhibitor; PO, oral; QW, every week; Q2W, every 2 weeks; Q4W, every 4 weeks; RRMM, relapsed/refractory multiple myeloma; sCR, stringent complete response; VGPR, very good partial response.
a
b
c
d
e
f
g
D-Pd (n=151) | Pd (n=153) | |
---|---|---|
Age, years | ||
Median (range) | 67 (42-86) | 68 (35-90) |
Distribution, n (%) | ||
<65 | 63 (42) | 60 (39) |
65-<75 | 63 (42) | 62 (41) |
≥75 | 25 (17) | 31 (20) |
ECOG PS score, n (%) | ||
0 | 91 (60) | 77 (50) |
1 | 54 (36) | 57 (37) |
2 | 6 (4) | 19 (12) |
ISS disease stage, n (%)b | ||
I | 68 (45) | 69 (45) |
II | 50 (33) | 51 (33) |
III | 33 (22) | 33 (22) |
Type of MM, n (%) | ||
IgG | 62 (41) | 63 (41) |
IgA | 24 (16) | 20 (13) |
Light chain | 24 (16) | 25 (16) |
Cytogenetic profilec | ||
N | 103 | 108 |
Standard risk, n (%) | 64 (62) | 73 (68) |
High risk, n (%) | 39 (38) | 35 (32) |
Time since MM diagnosis, years | ||
Median (range) | 4.4 (0.5-20.0) | 4.5 (0.6-19.0) |
Prior LOTs | ||
Median (range) | 2 (1-5) | 2 (1-5) |
Distribution, n (%) | ||
1 | 16 (11) | 18 (12) |
2-3 | 114 (75) | 113 (74) |
≥4 | 21 (14) | 22 (14) |
Prior PI or IMiD, n (%) | 151 (100) | 153 (100) |
Prior ASCT, n (%) | 90 (60) | 81 (53) |
Disease refractory to last LOT, n (%) | 122 (81) | 123 (80) |
Disease refractory to, n (%) | ||
Lenalidomide | 120 (79) | 122 (80) |
PI | 71 (47) | 75 (49) |
PI + lenalidomide | 64 (42) | 65 (42) |
Abbreviations: ASCT, autologous stem cell transplantation; D-Pd, daratumumab + pomalidomide + dexamethasone; ECOG PS, Eastern Cooperative Oncology Group performance status; IgA, immunoglobulin A; IgG, immunoglobulin G; IMiD, immunomodulatory drug; ISS, International Staging System; ITT, intention-to-treat; LOT, line of therapy; MM, multiple myeloma; Pd, pomalidomide + dexamethasone; PI, proteasome inhibitor. aITT population (N=304). bDerived from the combination of serum β2-microglobulin and albumin concentrations; higher stages indicate more severe disease. cCytogenetic risk based on fluorescence in-situ hybridization; patients with high-risk cytogenetic profile had ≥1 high-risk abnormality (del17p, t[4;14], or t[14;16]). |
Parameter | D-Pd (n=151) | Pd (n=153) |
---|---|---|
Patients treated, n (%) | 149 (99) | 150 (98) |
Ongoing at clinical cutoff, n (%)a | 60 (40) | 33 (22) |
Discontinued, n (%)a | 89 (60) | 117 (78) |
Progressive disease | 66 (44) | 87 (58) |
Death | 10 (7) | 7 (5) |
Adverse event | 3 (2) | 4 (3) |
Physician decision | 4 (3) | 7 (5) |
Lost to follow-up | 1 (1) | 0 |
Noncompliance with study drug | 5 (3) | 12 (8) |
Abbreviations: D-Pd, daratumumab + pomalidomide + dexamethasone; Pd, pomalidomide + dexamethasone. aPercentages calculated using patients treated as denominator (D-Pd, n=149; Pd, n=150). |
Number of Progression Events or Deaths/Total Number | D-Pd | Pd | HR (95% CI) |
---|---|---|---|
Overall | 84/151 | 106/153 | 0.63 (0.47-0.85) |
Sex | |||
Male | 46/79 | 54/82 | 0.69 (0.44-1.09) |
Female | 38/72 | 52/71 | 0.55 (0.38-0.81) |
Age | |||
<65 years | 36/63 | 41/60 | 0.69 (0.44-1.09) |
≥65 years | 48/88 | 65/93 | 0.55 (0.38-0.81) |
Race | |||
White | 75/135 | 93/137 | 0.66 (0.48-0.89) |
Non-white | 9/16 | 13/16 | 0.34 (0.14-0.82) |
ISS disease staging | |||
1 | 31/68 | 43/69 | 0.62 (0.39-0.98) |
2 | 32/50 | 36/51 | 0.54 (0.33-0.87) |
3 | 21/33 | 27/33 | 0.75 (0.42-1.32) |
Revised ISS disease staging | |||
1 | 11/26 | 17/25 | 0.51 (0.24-1.10) |
2 | 45/74 | 64/88 | 0.58 (0.39-0.85) |
3 | 15/19 | 11/14 | 1.38 (0.62-3.11) |
Number of prior LOTs | |||
1 | 9/16 | 12/18 | 0.70 (0.30-1.67) |
2-3 | 65/114 | 79/113 | 0.66 (0.48-0.92) |
≥4 | 10/21 | 15/22 | 0.40 (0.18-0.90) |
Baseline creatinine clearance | |||
≤60 mL/min | 23/40 | 36/47 | 0.59 (0.35-0.99) |
>60 mL/min | 61/111 | 70/106 | 0.64 (0.45-0.90) |
Type of MM | |||
IgG | 43/76 | 52/79 | 0.67 (0.45-1.01) |
Non-IgG | 20/34 | 25/32 | 0.44 (0.24-0.81) |
Cytogenetic profile | |||
High risk | 28/39 | 26/35 | 0.85 (0.49-1.44) |
Standard risk | 30/64 | 50/73 | 0.51 (0.32-0.81) |
Baseline hepatic function | |||
Normal | 69/136 | 88/127 | 0.56 (0.41-0.77) |
Impaired | 15/15 | 18/26 | 1.72 (0.84-3.50) |
ECOG PS | |||
0 | 49/91 | 53/77 | 0.61 (0.41-0.90) |
≥1 | 35/60 | 53/76 | 0.65 (0.42-1.00) |
Refractory to lenalidomide | |||
No | 8/31 | 17/31 | 0.36 (0.15-0.83) |
Yes | 76/120 | 89/122 | 0.66 (0.49-0.90) |
Refractory to PIs | |||
No | 38/80 | 52/78 | 0.53 (0.35-0.80) |
Yes | 46/71 | 54/75 | 0.73 (0.49-1.08) |
Refractory to last LOT | |||
No | 9/29 | 16/30 | 0.45 (0.20-1.02) |
Yes | 75/122 | 90/123 | 0.64 (0.47-0.87) |
Abbreviations: CI, confidence interval; D-Pd, daratumumab + pomalidomide + dexamethasone; ECOG PS, Eastern Cooperative Oncology Group performance status; HR, hazard ratio; IgG, immunoglobulin G; ISS, International Staging System; LOT, line of therapy; MM, multiple myeloma; Pd, pomalidomide + dexamethasone; PFS, progression-free survival; PI, proteasome inhibitor. |
n (%) | D-Pd (n=149) | Pd (n=150) | ||||
---|---|---|---|---|---|---|
Grade 1/2 | Grade 3 | Grade 4 | Grade 1/2 | Grade 3 | Grade 4 | |
Hematologic | ||||||
Neutropenia | 4 (3) | 37 (25) | 64 (43) | 4 (3) | 49 (33) | 27 (18) |
Anemia | 30 (20) | 24 (16) | 1 (1) | 34 (23) | 31 (21) | 1 (1) |
Thrombocytopenia | 22 (15) | 13 (9) | 13 (9) | 23 (15) | 19 (13) | 8 (5) |
Leukopenia | 14 (9) | 16 (11) | 9 (6) | 11 (7) | 6 (4) | 1 (1) |
Lymphopenia | 4 (3) | 10 (7) | 8 (5) | 7 (5) | 3 (2) | 2 (1) |
Febrile neutropenia | 0 | 10 (7) | 3 (2) | 0 | 3 (2) | 1 (1) |
Nonhematologic | ||||||
Infections | 61 (41) | 32 (21) | 4 (3) | 48 (32) | 29 (19) | 1 (1) |
Upper respiratory tract infection | 34 (23) | 0 | 0 | 21 (14) | 3 (2) | 0 |
Pneumonia | 10 (7) | 14 (9) | 3 (2) | 8 (5) | 8 (5) | 1 (1) |
Lower respiratory tract infection | 12 (8) | 14 (9) | 2 (1) | 10 (7) | 11 (7) | 2 (1) |
Fatigue | 26 (17) | 12 (8) | 0 | 31 (21) | 7 (5) | 0 |
Asthenia | 25 (17) | 7 (5) | 1 (1) | 23 (15) | 1 (1) | 0 |
Diarrhea | 25 (17) | 8 (5) | 0 | 20 (13) | 1 (1) | 0 |
Pyrexia | 29 (20) | 0 | 0 | 21 (14) | 0 | 0 |
Hyperglycemia | 7 (5) | 7 (5) | 1 (1) | 12 (8) | 7 (5) | 0 |
Second primary malignancy | 3 (2) | NA | NA | 3 (2) | NA | NA |
Any infusion-related reaction | 8 (5) | 0 | 0 | NA | NA | NA |
Abbreviations: AE, adverse event; D-Pd, daratumumab + pomalidomide + dexamethasone; NA, not applicable; Pd, pomalidomide + dexamethasone. aAEs of any grade that were reported in ≥15% of patients in either treatment group or grade 3/4 AEs that were reported in ≥5% of patients in either treatment group are listed. |
Total Receiving Subsequent Therapy, n (%) | Any Subsequent LOT | Next Subsequent LOT | ||
---|---|---|---|---|
D-Pdb (n=72) | Pd (n=102) | D-Pdb (n=72) | Pd (n=102) | |
Dexamethasone | 57 (79) | 83 (81) | 51 (71) | 72 (71) |
Carfilzomib | 31 (43) | 34 (33) | 24 (33) | 24 (24) |
Cyclophosphamide | 26 (36) | 36 (35) | 13 (18) | 19 (19) |
Bortezomib | 20 (28) | 37 (36) | 10 (14) | 26 (25) |
Pomalidomide | 14 (19) | 23 (23) | 7 (10) | 14 (14) |
Lenalidomide | 11 (15) | 19 (19) | 10 (14) | 11 (11) |
Selinexor | 11 (15) | 2 (2) | 5 (7) | 0 |
Thalidomide | 8 (11) | 3 (3) | 4 (6) | 1 (1) |
DARZALEX | 5 (7) | 66 (65) | 4 (6) | 47 (46) |
Abbreviations: D-Pd, daratumumab + pomalidomide + dexamethasone; LOT, line of therapy; Pd, pomalidomide + dexamethasone. aSubsequent systemic antimyeloma therapy was reported based on therapeutic class, pharmacological class, and preferred term. bD-Pd arm included all patients who received DARZALEX, regardless of the route of administration, with Pd. Note: Percentages have been rounded and therefore might not add up to 100%. |
TEAE, n (%) | D-Pd (n=149) | Pd (n=150) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Grade 1/2 | Grade 3 | Grade 4 | Grade 5 | Total | Grade 1/2 | Grade 3 | Grade 4 | Grade 5 | Total | |
Any AEs | 12 (8) | 45 (30) | 75 (50) | 13 (9) | 145 (97) | 23 (15) | 79 (53) | 31 (21) | 13 (9) | 146 (97) |
Hematologic | ||||||||||
Anemia | 30 (20) | 26 (17) | 1 (1) | 0 | 57 (38) | 35 (23) | 31 (21) | 1 (1) | 0 | 67 (45) |
Thrombocytopenia | 23 (15) | 14 (9) | 13 (9) | 0 | 50 (34) | 23 (15) | 20 (13) | 8 (5) | 0 | 51 (34) |
Leukopenia | 14 (9) | 16 (11) | 9 (6) | 0 | 39 (26) | 11 (7) | 6 (4) | 1 (1) | 0 | 18 (12) |
Neutropenia | 4 (3) | 37 (25) | 66 (44) | 0 | 107 (72) | 4 (3) | 48 (32) | 28 (19) | 0 | 80 (53) |
Lymphopenia | 3 (2) | 11 (7) | 8 (5) | 0 | 22 (15) | 7 (5) | 3 (2) | 2 (1) | 0 | 12 (8) |
Bone marrow failure | 0 | 0 | 0 | 1 (1) | 1 (1) | 0 | 0 | 0 | 0 | 0 |
Febrile neutropenia | 0 | 10 (7) | 3 (2) | 0 | 13 (9) | 0 | 4 (3) | 1 (1) | 0 | 5 (3) |
Nonhematologic | ||||||||||
Upper respiratory tract infection | 37 (25) | 0 | 0 | 0 | 37 (25) | 21 (14) | 3 (2) | 0 | 0 | 24 (16) |
Pyrexia | 31 (21) | 0 | 0 | 0 | 31 (21) | 26 (17) | 0 | 0 | 0 | 26 (17) |
Diarrhea | 28 (19) | 8 (5) | 0 | 0 | 36 (24) | 22 (15) | 1 (1) | 0 | 0 | 23 (15) |
Fatigue | 28 (19) | 15 (10) | 0 | 0 | 43 (29) | 31 (21) | 7 (5) | 0 | 0 | 38 (25) |
Asthenia | 25 (17) | 7 (5) | 1 (1) | 0 | 33 (22) | 23 (15) | 2 (1) | 0 | 0 | 25 (17) |
Peripheral edema | 25 (17) | 0 | 0 | 0 | 25 (17) | 14 (9) | 0 | 0 | 0 | 14 (9) |
Bronchitis | 22 (15) | 0 | 0 | 0 | 22 (15) | 15 (10) | 3 (2) | 0 | 0 | 18 (12) |
Dyspnea | 12 (8) | 3 (2) | 1 (1) | 1 (1) | 17 (11) | 12 (8) | 1 (1) | 0 | 0 | 13 (9) |
Lower respiratory tract infection | 12 (8) | 14 (9) | 2 (1) | 1 (1) | 29 (19) | 10 (7) | 11 (7) | 2 (1) | 1 (1) | 24 (16) |
COVID-19 | 10 (7) | 5 (3) | 1 (1) | 2 (1) | 18 (12) | 2 (1) | 0 | 0 | 1 (1) | 3 (2) |
Hyperglycemia | 9 (6) | 8 (5) | 1 (1) | 0 | 18 (12) | 13 (9) | 7 (5) | 0 | 0 | 20 (13) |
Muscular weakness | 9 (6) | 0 | 1 (1) | 0 | 10 (7) | 5 (3) | 0 | 0 | 0 | 5 (3) |
Pneumonia | 9 (6) | 14 (9) | 4 (3) | 3 (2) | 30 (20) | 9 (6) | 9 (6) | 1 (1) | 2 (1) | 21 (14) |
Hypokalemia | 6 (4) | 6 (4) | 1 (1) | 0 | 13 (9) | 8 (5) | 1 (1) | 0 | 0 | 9 (6) |
Hyperuricemia | 3 (2) | 1 (1) | 1 (1) | 0 | 5 (3) | 3 (2) | 0 | 1 (1) | 0 | 4 (3) |
Myocardial ischemia | 2 (1) | 0 | 0 | 0 | 2 (1) | 0 | 0 | 1 (1) | 0 | 1 (1) |
Acute myocardial infarction | 1 (1) | 1 (1) | 0 | 0 | 2 (1) | 0 | 0 | 0 | 1 (1) | 1 (1) |
General physical health deterioration | 1 (1) | 1 (1) | 0 | 0 | 2 (1) | 0 | 2 (1) | 0 | 2 (1) | 4 (3) |
Hyperbilirubinemia | 1 (1) | 0 | 1 (1) | 0 | 2 (1) | 1 (1) | 0 | 0 | 0 | 1 (1) |
Lumbar vertebral fracture | 1 (1) | 0 | 1 (1) | 0 | 2 (1) | 0 | 2 (1) | 0 | 0 | 2 (1) |
Acute pulmonary edema | 0 | 0 | 1 (1) | 0 | 1 (1) | 0 | 0 | 0 | 0 | 0 |
Campylobacter infection | 0 | 0 | 0 | 1 (1) | 1 (1) | 0 | 0 | 0 | 0 | 0 |
Cardiac arrest | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 (1) | 1 (1) |
Cerebral hemorrhage | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 (1) | 1 (1) |
Embolism | 0 | 0 | 1 (1) | 0 | 1 (1) | 0 | 0 | 0 | 0 | 0 |
Hypertensive hydrocephalus | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 (1) | 1 (1) |
Liver disorder | 0 | 0 | 0 | 1 (1) | 1 (1) | 0 | 0 | 0 | 0 | 0 |
Pneumonia aspiration | 0 | 0 | 0 | 1 (1) | 1 (1) | 0 | 0 | 0 | 1 (1) | 1 (1) |
Respiratory failure | 0 | 1 (1) | 0 | 1 (1) | 2 (1) | 1 (1) | 1 (1) | 1 (1) | 0 | 3 (2) |
Sepsis | 0 | 1 (1) | 0 | 1 (1) | 2 (1) | 0 | 0 | 1 (1) | 0 | 1 (1) |
Septic shock | 0 | 0 | 0 | 1 (1) | 1 (1) | 0 | 0 | 0 | 2 (1) | 2 (1) |
Sudden death | 0 | 0 | 0 | 1 (1) | 1 (1) | 0 | 0 | 0 | 0 | 0 |
Systemic candida | 0 | 0 | 0 | 1 (1) | 1 (1) | 0 | 0 | 0 | 0 | 0 |
Viral pneumonia | 0 | 0 | 1 (1) | 0 | 1 (1) | 0 | 0 | 0 | 0 | 0 |
Abbreviations: AE, adverse event; COVID-19, Coronavirus Disease 2019; D-Pd, daratumumab + pomalidomide + dexamethasone; MedDRA, Medical Dictionary for Regulatory Activities; NCI-CTCAE, National Cancer Institute Common Terminology Criteria for Adverse Events; Pd, pomalidomide + dexamethasone; TEAE, treatment-emergent adverse event. aTEAEs are listed for all grade 4 or 5 events and any grade 3 event occurring in ≥15% of patients in either treatment group (corresponding grade 1 or 2 events are listed). Each patient could have >1 event, and multiple occurrences of each event but were only counted once for each row. |
Disposition and Drug Exposure
(N=103) | |
---|---|
Median (range) age, years | 64 (35-86) |
Age category, n (%) | |
<65 years | 52 (51) |
≥75 years | 8 (8) |
Male, % | 55 |
Race, n (%) | |
White | 79 (77) |
Other | 24 (23) |
High-risk cytogenetic profilea | 22/87 (25) |
del17p | 16 (18) |
t(4;14) | 6 (7) |
t(14;16) | 1 (1) |
Baseline ECOG PS score, n (%) | |
0 | 28 (27) |
1 | 63 (61) |
2 | 12 (12) |
>2 | 0 (0) |
Type of myeloma, n (%) | |
IgG | 63 (61) |
IgA | 18 (18) |
IgD | 2 (2) |
Light chain | 20 (19) |
Median (range) time from diagnosis, years | 5.1 (0.4-16.0) |
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; ECOG PS, Eastern Cooperative Oncology Group performance status; Ig, immunoglobulin. aThe presence of high-risk cytogenetic abnormalities was adjudicated locally per individual center practices. |
Characteristic | D-Pd (N=103) |
---|---|
Median (range) prior LOTs, n (%) | 4 (1-13) |
Prior LOTs, n (%) | |
1a | 3 (3) |
2 | 22 (21) |
3 | 25 (24) |
>3 | 53 (52) |
Autologous stem cell transplant | 76 (74) |
Prior therapy with, n (%) | |
PI | 102 (99) |
Carfilzomib | 34 (33) |
Bortezomib | 101 (98) |
Ixazomib | 2 (2) |
Lenalidomide | 103 (100) |
Thalidomide | 29 (28) |
Bortezomib + lenalidomide | 101 (98) |
Bortezomib + lenalidomide + carfilzomib | 34 (33) |
Steroids | 103 (100) |
Chemotherapy | 103 (100) |
PI and immunomodulatory drug | 102 (99) |
Refractory to, n (%) | |
PI | 9 (9) |
IMiD | 21 (20) |
PI and IMiD | 73 (71) |
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; IMiD, immunomodulatory drug; LOT, line of therapy; PI, proteasome inhibitor. aThree patients were identified by investigators as having ≥2 prior LOTs but per International Myeloma Working Group criteria, they were later determined to have received only 1 prior LOT that included both bortezomib and lenalidomide. |
(N=103) | ||
---|---|---|
Any Grade | Grade ≥3 | |
Neutropenia | 83 (80.6) | 81 (78.6) |
Anemia | 57 (55.3) | 29 (28.2) |
Fatigue | 54 (52.4) | 13 (12.6) |
Diarrhea | 51 (49.5) | 5 (4.9) |
Thrombocytopenia | 44 (42.7) | 20 (19.4) |
Cough | 42 (40.8) | 0 (0) |
Leukopenia | 40 (38.8) | 25 (24.3) |
Constipation | 37 (35.9) | 0 (0) |
Nausea | 36 (35.0) | 0 (0) |
Dyspnea | 34 (33.0) | 8 (7.8) |
Pyrexia | 34 (33.0) | 2 (1.9) |
Back pain | 33 (32.0) | 6 (5.8) |
Upper respiratory tract infection | 33 (32.0) | 3 (2.9) |
Muscle spasms | 30 (29.1) | 1 (1.0) |
Vomiting | 29 (28.2) | 2 (1.9) |
Arthralgia | 28 (27.2) | 2 (1.9) |
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; TEAE, treatment-emergent adverse event. |
Subgroups | N | ORR | 95% CI |
---|---|---|---|
All patients | 103 | 60.2 | (50.1-69.7) |
Sex | |||
Male | 57 | 54.4 | (40.7-67.6) |
Female | 46 | 67.4 | (52.0-80.5) |
Age, years | |||
<65 | 52 | 57.7 | (43.2-71.3) |
≥65 | 51 | 62.7 | (48.1-75.9) |
Renal function (baseline creatinine clearance) | |||
<60 mL/min | 31 | 58.1 | (39.1-75.5) |
≥60 mL/min | 72 | 61.1 | (48.9-72.4) |
Baseline hepatic function | |||
Normal | 84 | 65.5 | (54.3-75.5) |
Impaireda | 19 | 36.8 | (16.3-61.6) |
Number of prior LOTs | |||
2 lines | 22 | 63.6 | (40.7-82.8) |
3 lines | 26b | 65.4 | (44.3-82.8) |
>3 lines | 53 | 54.7 | (40.4-68.4) |
Refractoriness | |||
PI and immunomodulatory drug | 73 | 57.5 | (45.4-69.0) |
Measurable type of MM | |||
IgG | 56 | 53.6 | (39.7-67.0) |
Non-IgG | 17 | 58.8 | (32.9-81.6) |
Cytogenic risk | |||
Standard risk | 65 | 58.5 | (45.6-70.6) |
High risk | 22 | 59.1 | (36.4-79.3) |
Abbreviations: CI, confidence interval; D-Pd, DARZALEX + pomalidomide + dexamethasone; IgG, immunoglobulin G; LOT, line of therapy; MM, multiple myeloma; ORR, overall response rate; PI, proteasome inhibitor. aClassified as mild, moderate or severe; 17% mild impairment, 1% moderate impairment, 0% severe impairment. Patients with impaired hepatic function received few doses of DARZALEX vs patients with normal hepatic function. bDiscrepancy from demographics table due to update of concomitant medication data. |
Patient Characteristics
Characteristic | D-Pd ITT Population (n=112) |
---|---|
Age, median (range), years | 66.5 (39-83) |
Age category, n (%) | |
≤65 years | 50 (44.6) |
>65 to ≤75 years | 50 (44.6) |
>75 years | 12 (10.7) |
Male/female, n (%) | 76 (67.9)/36 (32.1) |
Race, n (%) | |
White | 91 (81.3) |
Black or African American | 10 (8.9) |
Asian | 6 (5.4) |
Others | 5 (4.5) |
ECOG PSa, n (%) | |
0 | 44 (39.3) |
1 | 67 (59.8) |
R-ISS stage, n (%) | |
I | 31 (27.7) |
II | 52 (46.4) |
III | 8 (7.1) |
NE | 21 (18.8) |
Time from first diagnosis, median (range), years | 3.4 (0.5-11.5) |
Status of most recent prior LEN-containing treatment, n (%) | |
LEN-relapsed | 27 (24.1) |
LEN-refractory | 85 (75.9) |
Prior lines of therapy, n (%) | |
1 | 69 (61.6) |
2 | 43 (38.4) |
Prior stem cell transplant, n (%) | 78 (69.6) |
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; ECOG PS, Eastern Cooperative Oncology Group performance status; ITT, intention-to-treat; LEN, lenalidomide; NE, not evaluable; R-ISS, Revised International Staging System. a1 patient had an ECOG PS of 2. |
Patient Disposition
Reason, n (%) | D-Pd (N=112) |
---|---|
Continuing treatment | 15 (13.4) |
Discontinued treatment | 97 (86.6) |
Disease progression | 54 (48.2) |
Withdrawal by patient | 23 (20.5) |
Adverse event | 10 (8.9) |
Death | 3 (2.7) |
Transition to commercially available treatment | 2 (1.8) |
Other | 3 (2.7) |
Unknown | 2 (1.8) |
Patients continuing in follow-up | 22 (19.6) |
Discontinued study | 75 (67) |
Death | 50 (44.6) |
Withdrawal by patient | 19 (17.0) |
Lost to follow-up | 2 (1.8) |
Other | 4 (3.6) |
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone. |
Drug Exposure
Efficacy
Baseline Characteristics | OS, Median Months | 95% CI |
---|---|---|
Overall | 56.7 | (46.5-NR) |
Age, years | ||
≤65 | NR | (43.6-NR) |
>65 | 54.4 | (24.1-NR) |
ECOG PS score | ||
<1 | 59.8 | (47.6-NR) |
≥1 | 56.6 | (28.5-NR) |
Creatinine clearance | ||
<30 mL/min | NA | NA |
≥30 and <45 mL/min | NA | NA |
≥45 and <60 mL/min | NR | (28.6-NR) |
≥60 mL/min | 49.1 | (34.9-NR) |
Missing | NR | (20.5-NR) |
Prior stem cell transplant | ||
Yes | 60.3 | (43.6-NR) |
No | 56.6 | (24.1-NR) |
Duration of the most recent LEN | ||
≤24 months | 41.3 | (21.2-56.7) |
>24 months | NR | (54.4-NR) |
Immediately prior LEN dose | ||
>10 mg | 53.6 | (28.6-NR) |
≤10 mg | NR | (38.4-NR) |
Missing | NA | NA |
Number of prior antimyeloma lines | ||
1 | 56.6 | (41.3-NR) |
2 | NR | NR (22.8-NR) |
Status after most recent prior LEN | ||
Refractory | 53.6 | (28.6-NR) |
Relapsed | NR | (47.6-NR) |
Baseline β-2 microglobulin | ||
<3.5 mg/L | NR | (49.1-NR) |
≥3.5 mg/L and <5.5 mg/L | 54.4 | (21.3-NR) |
≥5.5 mg/L | 21.2 | (13.3-NR) |
Missing | NR | (25.5-NR) |
Prior LEN+proteasome inhibitor | ||
Yes | 54.4 | (42.5-NR) |
No | 56.7 | (28.6-NR) |
Triplet induction | ||
<3 agents | NR | (24.1-NR) |
≥3 agents | 54.4 | (42.5-NR) |
Calculated R-ISS stage | ||
I | NR | (53.6-NR) |
II | 35 | (21.3-56.6) |
III | 34.4 | (6.1-NR) |
NE | NR | (41.3-NR) |
Cytogenetic abnormality | ||
High risk | 35 | (18.7-NR) |
Standard risk | 56.7 | (38.4-NR) |
NE | NR | (41.3-NR) |
Abbreviations: CI, confidence interval; ECOG PS, Eastern Cooperative Oncology Group performance status; LEN, lenalidomide; NA, not applicable; NE, not evaluable; NR, not reached; OS, overall survival; R-ISS, Revised International Staging System. |
D-Pd ITTb Population (N=112) | LEN-Relapsedc (n=27) | LEN-Refractoryd (n=85) | |
---|---|---|---|
ORRa (95% CI) | 78.6 (69.8-85.8) | 81.5 (61.9-93.7) | 77.6 (67.3-86) |
CR% | 26.8 | 40.7 | 22.4 |
VGPR% | 25.9 | 25.9 | 25.9 |
PR% | 25.9 | 14.8 | 29.4 |
MR | 8 | 7.4 | 8.2 |
SD | 6.3 | 3.7 | 7.1 |
PD | 3.6 | 3.7 | 3.5 |
Abbreviations: CI, confidence interval; CR, complete response, D-Pd, DARZALEX + pomalidomide + dexamethasone; ITT, intention-to-treat; LEN, lenalidomide; MR, minimal response; ORR, overall response rate; PD, progressive disease; PR, partial response; SD, stable disease; VGPR, very good partial response. aDue to rounding, the sum of individual response rates (CR + VGPR+ PR) may not exactly equal the ORR. bPatients were NE/missing. cPatient was NE/missing. dPatients were NE/missing. |
TEAEs Observed in ≥5% of Patients, n (%) | D-Pd (N=112) |
---|---|
Hematologic TEAEs | |
Neutropenia | 72 (64.3) |
Anemia | 22 (19.6) |
Thrombocytopenia | 16 (14.3) |
Febrile neutropenia | 11 (9.8) |
Leukopenia | 11 (9.8) |
Nonhematologic TEAEs | |
Pneumonia | 20 (17.9) |
Decreased neutrophil count | 10 (8.9) |
Hypertension | 10 (8.9) |
Dyspnea | 8 (7.1) |
Back pain | 7 (6.3) |
Fatigue | 7 (6.3) |
Decreased WBC | 6 (5.4) |
Sepsis | 6 (5.4) |
Chronic obstructive pulmonary disease | 6 (5.4) |
Hyperglycemia | 6 (5.4) |
Hypokalemia | 6 (5.4) |
Atrial fibrillation | 6 (5.4) |
Insomnia | 6 (5.4) |
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; TEAE, treatment-emergent adverse event; WBC, white blood cells. |
Patients With TEAEs, n (%) | D-Pd (N=112) | ||
---|---|---|---|
Pomalidomide | Dexamethasone | DARZALEX | |
Discontinuation of and related to study drug | 7 (6.3)a | 9 (8.0)a | 6 (5.4)b |
Dose reduction of and related to study drug (≥5% of patients for any drug) | 31 (27.7) | 38 (33.9) | 0 |
Neutropenia | 17 (15.2) | 0 | 0 |
Insomnia | 0 | 10 (8.9) | 0 |
Peripheral edema | 0 | 6 (5.4) | 0 |
Dose interruption of and related to study drug (≥5% of patients for any drug) | 55 (49.1) | 17 (15.2) | 65 (58) |
Neutropenia | 38 (33.9) | 3 (2.7) | 30 (26.8) |
Pneumonia | 7 (6.3) | 5 (4.5) | 5 (4.5) |
Leukopenia | 4 (3.6) | 0 | 6 (5.4) |
Infusion-related reaction | 0 | 0 | 26 (23.2) |
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; TEAE, treatment-emergent adverse event. aIncluded 1 case each of leukopenia and thrombocytopenia. bIncluded 1 case each of leukopenia, thrombocytopenia, and febrile neutropenia. |
A literature search of MEDLINE®
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