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DARZALEX + DARZALEX FASPRO - Adverse Event - Infections in Patients with Newly Diagnosed Multiple Myeloma

Last Updated: 06/30/2025

SUMMARY

  • Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.
  • There are no systemically collected data on the management of infections with DARZALEX/DARZALEX FASPRO treatment. Clinical judgment should be exercised when managing infections during DARZALEX/DARZALEX FASPRO-containing treatment regimens.
  • Janssen does not recommend the use of DARZALEX/DARZALEX FASPRO in a manner that is inconsistent with the approved labeling.

Transplant-Eligible

  • CASSIOPEIA: phase 3 study evaluating the safety and efficacy of DARZALEX for intravenous (IV) use in combination with bortezomib, thalidomide, and dexamethasone (D-VTd) in transplant eligible patients with previously untreated multiple myeloma (MM).1
    • Part 1: Moreau et al (2019)1 reported results from Part 1 of the CASSIOPEIA study. Infections of any grade were an adverse event (AE) of interest. In the D-VTd arm vs bortezomib, thalidomide, and dexamethasone (VTd) arm, any grade infections were reported in 65% vs 57% of patients, and grade 3/4 infections were reported in 22% vs 20% of patients.
    • Part 2: Moreau et al (2021)2,3 reported results from Part 2 of the CASSIOPEIA study. Infections occurred in 77.5% of patients in the DARZALEX monotherapy arm vs 64% in the observation arm.
  • GRIFFIN: phase 2, 2-part study evaluating the safety and efficacy of DARZALEX when administered in combination with bortezomib, lenalidomide, and dexamethasone (D-VRd) in patients with newly diagnosed multiple myeloma (NDMM) eligible for high-dose chemotherapy (HDT) and autologous stem cell transplantation (ASCT).4-6
    • Part 1: Voorhees et al (2021)7 reported the final analysis of the safety run-in cohort (N=16) of the GRIFFIN study with a median follow-up of 40.8 months. Fourteen (87.5%) patients experienced any grade infections, and 5 (31.3%) patients experienced grade 3/4 infections.
    • Part 2: Voorhees et al (2020)5,6 presented the primary analysis of the randomized portion of this study (n=207). Similar rates of any grade and grade 3/4 infections occurred for D-VRd vs bortezomib, lenalidomide, and dexamethasone (VRd). Voorhees et al (2023)8 reported the final analysis results of the GRIFFIN study (median follow-up, 49.6 months) after all patients completed ≥1 year of long-term follow-up after the end-of-study treatment, death, or withdrawal. The median duration of follow-up was 49.6 months. In the D-VRd vs VRd arm, any grade infections were reported in 93% vs 66% of patients, respectively, and grade 3/4 infections were reported in 29% vs 26% of patients, respectively.
  • LYRA: phase 2 study evaluating the safety and efficacy of DARZALEX in combination with cyclophosphamide, dexamethasone, and bortezomib (CyBorD) for the treatment of MM in patients who have not received previous treatment or have relapsed after receiving only 1 line of treatment.9,10
    • Yimer et al (2022)11 reported the end-of-study analysis of LYRA. In patients with NDMM, the most common grade 3/4 infection-related treatment-emergent adverse event (TEAE) was pneumonia (3.5%).
  • PLEIADES: phase 2 study evaluating the clinical benefit of DARZALEX FASPRO for subcutaneous (SC) use administered in combination with 4 standard-of-care treatment regimens.12-16
    • Chari et al (2020)12 presented updated safety and efficacy results of the D-VRd arm for patients with transplant-eligible NDMM in the PLEIADES study (n=67). Pneumonia was reported in 3% of patients in this arm.
  • PERSEUS: phase 3 study evaluating the safety and efficacy of DARZALEX FASPRO when administered in combination with bortezomib, lenalidomide, and dexamethasone (D-VRd) vs VRd induction and consolidation followed by maintenance with DARZALEX FASPRO and lenalidomide (D-R) in D-VRd group or lenalidomide (R) in VRd group in patients with NDMM eligible for ASCT.17
    • Sonneveld et al (2023)17 reported safety and efficacy results from the PERSEUS study. At a median follow-up of 47.5 months (range, 0-54.4), the most common infection-related grade 3/4 AE recorded in the D-VRd vs VRd group was pneumonia (10.5% vs 6.1%).
  • MASTER was a phase 2 study evaluating the efficacy and safety of DARZALEX in combination with carfilzomib, lenalidomide, and dexamethasone (D-KRd) in patients with NDMM.18 The most common serious TEAE was pneumonia (n=8).
  • Rodriguez-Otero et al (2024)19 presented results from a post hoc analysis of the PERSEUS and GRIFFIN studies that evaluated the efficacy and safety of D-VRd vs VRd in patients aged ≥65 years. A higher incidence of grade 3/4 infections was observed in the D-VRd vs VRd group, with slightly higher rates in patients aged ≥65 years (36.3% vs 24.8%) than in all patients (29.5% vs 22.5%).

Transplant-INEligible

  • MAIA was phase 3 study evaluating the safety and efficacy of DARZALEX in combination with lenalidomide and dexamethasone (D-Rd) compared with lenalidomide and dexamethasone (Rd) in transplant-ineligible patients with NDMM.20
    • At a median follow-up of 89.3 months (range, 0-102.2), in the D-Rd arm vs Rd arm, deaths due to infections/infestations were reported in 2.5% vs 8.2% of patients.21
    • At a median follow-up of 64.5 months (range, 0-77.6), grade 3/4 infections occurred in 42.6% vs 29.6% of patients from the D-Rd vs Rd arm, respectively.22
  • ALCYONE: phase 3 study evaluating the safety and efficacy of bortezomib, melphalan, and prednisone (VMP) alone and DARZALEX + VMP (D-VMP) in patients with NDMM who were ineligible for HDT with ASCT.23
    • Mateos et al (2025)24 reported the final efficacy and safety analysis results of the ALCYONE study at a median follow-up of 86.7 months. Pneumonia was the most common grade 3/4 infection, reported by 16% of patients in the D-VMP group and 5% of patients in the VMP group.
  • PLEIADES: phase 2 study evaluating the clinical benefit of DARZALEX FASPRO for SC use administered in combination with 4 standard-of-care treatment regimens.12-16 Specifically, with:
    • Moreau et al (2020)16 presented updated safety and efficacy results of the D-VMP arms in the PLEIADES study (n=67). Pneumonia was reported in 7% of patients in the D-VMP arm.
  • AURIGA: phase 3 study evaluating the conversion rate to minimal residual disease (MRD)-negativity after maintenance treatment with DARZALEX FASPRO in combination with lenalidomide (D-R) vs R alone in patients with NDMM who are anti-cluster of differentiation (CD) 38 naïve, have a very good partial response or better (≥VGPR), and are MRD-positive following ASCT after standard-of-care induction/consolidation.25-27
    • Badros et al (2024)25,26,28 reported primary results from the phase 3 AURIGA study. Slightly higher occurrence rates of grade 3/4 infections (18.8% vs 13.3%) were observed with D-R vs R.
    • Foster et al (2024)29 presented a post hoc analysis of the phase 3 AURIGA study that evaluated clinically relevant subgroups at a median follow-up of 32.3 months. The clinically relevant subgroups included elderly and black patients, patients with high-risk disease per International Staging System (ISS) disease staging, and patients with a high cytogenetic risk per standard, revised, and IMS 2024 high-risk criteria. D-R maintenance did not increase grade 3/4 infection rates in patients ≥65 years of age.
  • CEPHEUS: phase 3 study evaluating the efficacy and safety of DARZALEX FASPRO in combination with bortezomib, lenalidomide, and dexamethasone (D-VRd) or VRd in patients with NDMM who are transplant ineligible (TIE) or for whom transplant is not planned as initial therapy (transplant deferred).30-32
    • Usmani et al (2025)32 reported results from the phase 3 CEPHEUS study at a median follow-up of 58.7 months (range, 0.1-64.7). The safety data were consistent with the established safety profile of each individual drug. Serious TEAEs occurred in 142 (72.1%) vs 131 (67.2%) of patients from the D-VRd vs VRd arm, respectively, with the most common serious TEAE being pneumonia (D-VRd, 13.7%; VRd, 12.8%). Any grade infections occurred in 91.9% vs 85.6% of patients from the D-VRd vs VRd arm, respectively. Grade 3/4 TEAE infections occurred in 40.1% and 31.8% of patients from the D-VRd vs VRd arm, respectively.
    • Zweegman et al (2025)33 presented a subgroup analysis to assess efficacy and safety outcomes from the CEPHEUS study based on frailty status in patients with NDMM who were TIE or transplant deferred. Safety profiles were generally consistent with the established profiles of DARZALEX FASPRO and VRd across frailty subgroups. Infections occurred in 49 (39.5%) vs 39 (29.5%) of patients in IMWG fit subgroup; 30 (41.1%) vs 23 (36.5%) of patients in IMWG intermediate fitness subgroup; 53 (37.9%) vs 44 (28.2%) in IFM nonfrail subgroup; 26 (45.6%) vs 18 (46.2%) in IFM frail subgroup, in D-VRd vs VRd arms respectively.
    • Facon et al (2025)34 presented a post hoc subgroup analysis of the phase 3 CEPHEUS study. The safety outcomes were consistent with the ITT population, with no new safety concerns and a lower rate of grade 5 treatment emergent adverse events (TEAEs) when censored for COVID-19. Additionally, the incidence of grade 3 or 4 TEAEs was 79.9% in the D-VRd group and 79.6% in the VRd group.
  • Other relevant literature has been identified in addition to the data summarized above and is listed in the References section for your information.35,36 

PRODUCT LABELING

CLINICAL DATA - Newly Diagnosed multiple myeloma - transplant-eligible

DARZALEX in Combination with Bortezomib, Thalidomide and Dexamethasone in Previously Untreated MM

CASSIOPEIA (MMY3006; NCT02541383) is an ongoing, open-label, 2-arm, multicenter, phase 3 study evaluating the safety and efficacy of D-VTd in patients with previously untreated MM who are eligible for HDT and ASCT.1 Moreau et al (2019)1 reported the results from Part 1 of this study. Moreau et al (2021)2,3 reported results from Part 2 of the CASSIOPEIA study. Safety results related to infections have been summarized below.

Results - Safety - Infection-Related Events in Part 1

  • Infections of any grade were an AE of interest. In the D-VTd arm, 65% (n=351) of patients and 57% (n=306) in the VTd arm reported infections of any grade.
  • Grade 3/4 infections were reported in 22% (n=118) of patients in the D-VTd arm and 20% (n=105) in the VTd arm. See Table: Most Common Infection-Related Adverse Events During Treatment in Safety Population (CASSIOPEIA Part 1).
  • Six patients discontinued DARZALEX treatment due to TEAEs of infections.
  • Among the most common serious adverse events (SAEs; ≥3% of patients in either arm), pneumonia was reported in 4% (n=19) in the D-VTd arm and 2% (n=9) in the VTd arm.
  • A total of 14 deaths were reported in the D-VTd arm and 32 in the VTd arm. Septic shock was reported as a cause of death (n=1) in the VTd arm.37

Most Common Infection-Related Adverse Events During Treatment in Safety Population (CASSIOPEIA Part 1)a,1
Event, n (%) 
D-VTd (n=536)
VTd (n=538)
Any Grade
Grade 3/4
Any Grade
Grade 3/4
Stomatitis
86 (16)
68 (13)
104 (19)
88 (16)
Abbreviations: D-VTd, DARZALEX + bortezomib + thalidomide + dexamethasone; VTd, bortezomib + thalidomide + dexamethasone.aAdverse events of any grade that were reported in at least 20% of patients in either treatment arm and grade 3 or 4 adverse events that were reported in at least 10% of patients in either treatment arm are listed.

Results - Safety - Infection-Related Events in Part 2

  • Infections occurred in 77.5% (n=341) of patients in the DARZALEX monotherapy arm vs 64% (n=284) in the observation arm.3
    • DARZALEX monotherapy arm vs observation arm had a greater incidence of pneumonia (n=29 [6.6%] vs n=19 [4.3%]) and lung infections (n=21 [4.8%] vs n=15 [3.4%]).3
  • Majority of infections were grade 1/2 (DARZALEX monotherapy arm, 303 of 331 [88.9%]; observation arm, 254 of 284 [89.4%]).3
  • See Table: Most Common Infection-Related AEs during Treatment/Observation in Maintenance-Specific Safety Population (CASSIOPEIA Part 2).
  • SAEs that occurred in >1% of patients in the DARZALEX monotherapy vs observation arms were pneumonia (n=11 [3%] vs n=7 [2%]) and lung infection (n=6 [1%] vs n=7 [2%]), respectively.
  • Two AEs led to death in the DARZALEX monotherapy arm (septic shock and natural killer-cell lymphoblastic lymphoma, n=1 each); both were treatment-related.

Most Common Infection-Related AEs during Treatment/Observation in Maintenance-Specific Safety Population (CASSIOPEIA Part 2)2
Event, n (%)
DARZALEX Monotherapy
(n=440)
Observation
(n=444)
Grade 1/2
Grade 3
Grade 4
Grade 1/2
Grade 3
Grade 4
Bronchitis
166 (38)
2 (<1)
1 (<1)
130 (29)
4 (1)
0 (0)
Nasopharyngitis
76 (17)
0 (0)
0 (0)
49 (11)
0 (0)
0 (0)
Upper respiratory tract infection
64 (15)
0 (0)
0 (0)
35 (8)
1 (<1)
0 (0)
Herpes Zoster
30 (7)
1 (<1)
0 (0)
63 (14)
2 (<1)
0 (0)
Pneumonia
18 (4)
10 (2)
1 (<1)
13 (3)
6 (1)
0 (0)
Abbreviation: AE, adverse event.Note: There were no grade 5 infection-related AEs reported in both the arms.

DARZALEX in Combination with Bortezomib, Lenalidomide and Dexamethasone

GRIFFIN (MMY2004; NCT02874742) is a 2-part, phase 2, randomized, active-controlled US study evaluating the safety and efficacy of DARZALEX in combination with VRd in patients with NDMM eligible for HDT and ASCT.4-6 Voorhees et al (2021)7 reported the final analysis of the safety run-in cohort (Part 1) of the GRIFFIN study. Voorhees et al (2020)6 presented the primary analysis and updated analysis of the randomized portion (Part 2) of this study (n=207). Voorhees et al (2023)8 reported the final efficacy and safety results at a median follow-up of 49.6 months after all patients completed ≥1 year of follow-up after the end-of-study treatment, died, or withdrew from study participation. Safety results related to infections have been summarized below.

Results - Safety - Infection-Related Events in Part 1

  • During cycle 1, 3 of 16 patients developed 4 dose-limiting toxicities (DLTs) fatigue, gastroenteritis, hypotension, and pneumonitis.
    • All DLTs were grade 3 and none resulted in treatment discontinuation during induction or consolidation therapy.
  • Fourteen (87.5%) patients experienced any grade infections, and 5 (31.3%) patients experienced grade 3/4 infections.
    • During the maintenance phase 31.3% (n=5) of patients experienced any grade infections. The most common being upper respiratory tract infections. One (6.3%) patient experienced 2 grade 3/4 infections (pneumonia and bronchitis).
  • Pneumonia was the most common grade 3/4 infection-related TEAE reported in 5 (31.3%) patients.

Results - Safety - Infection-Related Events in Part 2

  • Any grade infections were more common in the D-VRd vs VRd arm (93% [n=92] vs 66% [n=67]). Similar incidence rates were reported across treatment arms for grade 3/4 infections (D-VRd, 29%; VRd, 26%) and infections leading to treatment discontinuation (D-VRd, 2%; VRd, 3%).
    • During maintenance therapy (cycle 7 and onwards) in the D-VRd vs VRd arm, any grade infections occurred in 35% (n/N=31/89) vs 32% (n/N=23/71) of patients, respectively, and grade 3/4 infections occurred in 18% (n=16) vs 21% (n=15) of patients, respectively.
    • In the D-VRd vs VRd arm, Coronavirus Disease 2019 (COVID-19) infections were reported in 5% (n=5) vs 2% (n=2) of patients, respectively. Of these, 1 patient in each arm had a grade 3 COVID-19-related event (including 1 serious event in the D-VRd arm).
  • Pneumonia was the most common infection-related serious TEAE (D-VRd vs VRd, 15% vs 14%, respectively).
  • For the incidence of most common infection-related TEAEs by grade in the safety population, see Table: Most Common Infection-Related TEAEs in the Safety Population (GRIFFIN).

Most Common Infection-Related TEAEs in the Safety Population (GRIFFIN)a,8
TEAEs, n (%)
D-VRd (n=99)
VRd (n=102)
Grade 1/2
Grade 3
Grade 4
Grade 1/2
Grade 3
Grade 4
Pneumoniab
11 (11)
11 (11)
1 (1)
4 (4)
14 (14)
0 (0)
Cellulitis
6 (6)
0 (0)
1 (1)
3 (3)
1 (1)
0 (0)
Sepsis
0 (0)
1 (1)
2 (2)
0 (0)
1 (1)
0 (0)
Septic shock
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
1 (1)
Abbreviations: D-VRd, DARZALEX + bortezomib + lenalidomide + dexamethasone; TEAE, treatment-emergent adverse event; VRd, bortezomib + lenalidomide + dexamethasone.
aThe maximum intensity for each preferred term is listed, and TEAEs are listed for all grade 4/5 events and any grade 3 events occurring in ≥10% of patients in either treatment arm (corresponding grade 1/2 events are listed).bOne grade 5 event was recorded in the D-VRd arm.

DARZALEX in Combination with Cyclophosphamide, Bortezomib, and Dexamethasone

LYRA (NCT02951819) is a phase 2, single-arm, open-label, multicenter study evaluating the safety and efficacy of DARZALEX in combination with CyBorD for the treatment of MM in patients who had not received previous treatment or had relapsed after receiving only 1 line of treatment.9,10 Yimer et al (2022)11 reported the end-of-study analysis results of the LYRA study. Safety results related to infections reported in patients with NDMM are summarized below.

Results - Safety - Infection-Related Events in Patients with NDMM


Most Common Infection-Related TEAEs in the Safety Analysis Set (Induction phase; LYRA)a,b,11
Event, n (%)
NDMM (n=86)
Any Grade
Grade 3/4
Upper respiratory tract infection
30 (34.9)
0 (0)
Nasopharyngitis
11 (12.8)
0 (0)
Pneumonia
8 (9.3)
3 (3.5)
Sinusitis
7 (8.1)
1 (1.2)
Abbreviations: NDMM, newly diagnosed multiple myeloma; TEAE, treatment-emergent adverse event.
aAdverse events of any grade that were reported in at least 25% of patients and grade 3/4 adverse events that were reported in at least 10% of patients are listed.
bThe safety analysis set includes all patients who received ≥1 dose of study treatment.


Most Common Infection-Related TEAEs in the Safety Analysis Set (Maintenance phase; LYRA)a,b,11
Event, n (%)
NDMM
Transplant (n=36)
Non-transplant (n=39)
Any Grade
Grade 3/4
Any Grade
Grade 3/4
Upper respiratory tract infection
11 (30.6)
0 (0)
8 (20.5)
0 (0)
Abbreviations: NDMM, newly diagnosed multiple myeloma; TEAE, treatment-emergent adverse event.
aAdverse events of any grade that were reported in at least 20% of patients and grade 3/4 adverse events that were reported in at least 5% of patients are listed.
bThe safety analysis set includes all patients who received ≥1 dose of study treatment.

DARZALEX FASPRO in Combination With Bortezomib, Lenalidomide, and Dexamethasone

PERSEUS (MMY3014; NCT03710603) is an ongoing, open-label, multicenter, phase 3 study evaluating the efficacy and safety of D-VRd vs VRd induction and consolidation followed by maintenance with D-R in D-VRd group or lenalidomide in VRd group in patients with NDMM eligible for ASCT. Sonneveld et al (2023)17 reported efficacy and safety results from the PERSEUS study evaluating D-VRd vs VRd in patients with NDMM eligible for ASCT.

Results - Safety - Infection-Related Events

  • The most common infection-related grade 3/4 AE recorded in the D-VRd vs VRd group was pneumonia (10.5% vs 6.1%)
  • The number of deaths recorded due to COVID-19 in the D-VRd vs VRd group was 4 (1.1%) vs 1 (0.3%) patients, respectively.
  • For the incidence of most common infection-related AEs by grade, see Table: Most Common Infection-Related AEs (PERSEUS).
  • For the incidence of infection-related SAEs occurring in ≥2% of patients in either treatment group, see Table: Infection-Related SAEs Occurring in ≥2% of patients (PERSEUS).

Most Common Infection-Related AEs (PERSEUS)a,17
Event, n (%)
D-VRd (n=351)
VRd (n=347)
Any Grade
Grade 3/4
Any Grade
Grade 3/4
Infections
305 (86.9)
124 (35.3)
266 (76.7)
95 (27.4)
   COVID-19
123 (35)
12 (3.4)
83 (23.9)
4 (1.2)
   Upper respiratory tract
   infection

111 (31.6)
2 (0.6)
87 (25.1)
6 (1.7)
   Pneumonia
64 (18.2)
37 (10.5)
38 (11)
21 (6.1)
Abbreviations: AE, adverse event; COVID-19, coronavirus disease 2019; D-VRd, DARZALEX FASPRO + bortezomib + lenalidomide + dexamethasone; VRd, bortezomib + lenalidomide + dexamethasone.
aThe safety population included patients who received ≥1 dose of the study treatment. AEs of any grade that were reported in ≥20% of patients in either treatment group and grade 3/4 AEs that were reported in ≥10% of patients in either treatment group are listed.


Infection-Related SAEs Occurring in ≥2% of patients (PERSEUS)a,38
n (%)
D-VRd (n=351)
VRd (n=347)
Infections
123 (35)
95 (27.4)
   Pneumonia
40 (11.4)
21 (6.1)
   COVID-19
13 (3.7)
6 (1.7)
   COVID-19 pneumonia
11 (3.1)
5 (1.4)
   Lower respiratory tract infection
9 (2.6)
3 (0.9)
   Sepsis
7 (2)
9 (2.6)
   Upper respiratory tract infection
7 (2)
8 (2.3)
Abbreviations: COVID-19, coronavirus disease 2019; D-VRd, DARZALEX FASPRO + bortezomib + lenalidomide + dexamethasone; SAE, serious adverse event; VRd, bortezomib + lenalidomide + dexamethasone.
aThe safety population included patients who received ≥1 dose of the study treatment.

DARZALEX in Combination With Carfilzomib, Lenalidomide, and Dexamethasone

MASTER (NCT03224507) was a phase 2, single-arm, open-label, multicenter study evaluating the efficacy and safety of D-KRd in patients with NDMM.18 Costa et al (2023)18 reported the final analysis results of the MASTER study. Safety results related to infections have been summarized below.

Results - Safety - Infection-Related Events

  • The most common serious TEAE was pneumonia (n=8).
  • One patient died during protocol-directed therapy from metapneumovirus pneumonia, which was considered as not related to study treatment.
  • One patient died after therapy and while on MRD surveillance without disease progression from COVID-19 pneumonia.
  • For the incidence of most common infection-related TEAEs by grade, see Table: Most Common Infection-Related TEAEs (MASTER).

Most Common Infection-Related TEAEs (MASTER)a,18
Event, n (%)
D-KRd (n=123)
Grades 1 and 2
Grade 3
Grade 4
Grade 5
Upper respiratory tract infection
44 (36)
1 (1)
0 (0)
0 (0)
Lung infection
4 (3)
3 (2)
2 (2)
1 (1)
Abbreviations: D-KRd, DARZALEX + carfilzomib + lenalidomide + dexamethasone; TEAE, treatment-emergent adverse event.
aAssessed in the whole study population.

CLINICAL DATA - NEWLY DIAGNOSED MULTIPLE MYELOMA TRANSPLANT - INELIGIBLE

DARZALEX in Combination with Lenalidomide and Dexamethasone

MAIA (MMY3008; NCT02252172) is an international, phase 3, randomized, open-label, active-controlled, multicenter study in patients with NDMM not eligible for HDT and ASCT (N=737).20 Kumar et al (2022)39 presented the updated safety and efficacy results of the MAIA study at a median follow-up of 64.5 months. Facon et al (2024)21 presented the updated safety results for the D-Rd vs Rd arm of the MAIA study at a long-term median follow-up of around 89.3 months (range, 0-102.2). Safety results related to infections have been summarized below. Facon et al (2025)22 reported the updated efficacy and safety results from the MAIA study at a long-term median follow-up of 64.5 months.

Results - Safety - Infection-Related Events

  • At a median follow-up of 89.3 months (range, 0-102.2), in the D-Rd arm vs Rd arm, deaths due to infections/infestations were reported in 2.5% (n=9) vs 8.2% (n=30) of patients.21
  • At a median follow-up of 64.5 months (range, 0-77.6), grade 3/4 infections occurred in 42.6% vs 29.6% of patients from the D-Rd vs Rd arm, respectively.22

DARZALEX in Combination with Bortezomib, Melphalan, and Prednisone

ALCYONE (MMY3007; NCT02195479) is a multicenter, randomized, open-label, active-controlled, phase 3 study evaluating the safety and efficacy of D-VMP compared with VMP alone for the treatment of NDMM in patients (N=706) who were ineligible for HDT with ASCT.23 Mateos et al (2025)24 reported the final efficacy and safety analysis results of the ALCYONE study at a median follow-up of 86.7 months. Safety results related to infections have been summarized below.

Results - Safety - Infection-Related Events


Most Common Infection-Related TEAEs24
Event, n (%)
D-VMP
(n=346)

VMP
(n=354)

Any Gradea
Grade 1-2
Grade
3

Grade
4

Grade
5

Any Gradea
Grade
1-2

Grade
3

Grade
4

Grade
5

Upper respiratory
tract infection

107 (31)
99
(29)

7
(2)

0
1
(<1)

50
(14)

44
(12)

6
(2)

0
0
Bronchitis
77
(22)

66
(19)

11
(3)

0
0
27
(8)

24
(7)

3
(1)

0
0
Pneumonia
78
(23)

19
(5)

53
(15)

4
(1)

2
(1)

19
(5)

3
(1)

15
(4)

1
(<1)

0
Abbreviations: D-VMP, DARZALEX + bortezomib + melphalan + prednisone; TEAE, treatment-emergent adverse event; VMP, bortezomib + melphalan + prednisone.
aPreferred terms for any grade of TEAEs with an occurrence of ≥20% are reported.


Summary of Causes of Deaths Due to Infection40
Event, n (%)
D-VMP
(n=346)

VMP
(n=354)

Primary cause of death
   COVID-19
2 (1)
1 (<1)
Infections and infestations
19 (5)
22 (6)
   COVID-19
12 (3)
4 (1)
   Lung infection
4 (1)
8 (2)
   Sepsis
3 (1)
6 (2)
   Other
0
4 (1)
Abbreviations: COVID-19, coronavirus disease 2019; D-VMP, DARZALEX + bortezomib + melphalan + prednisone; TEAE, treatment-emergent adverse event; VMP, bortezomib + melphalan + prednisone
Treatment Discontinuation
  • One patient in the VMP group discontinued treatment due to grade 5 infection (bacterial pneumonia), with no corresponding discontinuations in the D-VMP group.24

Treatment Discontinuation Due to Infection40
Event, n (%)
D-VMP
(n=346)

VMP
(n=354)

Pneumonia
4 (1)
1 (<1)
Upper respiratory tract infection
2 (1)
0
Abbreviations: D-VMP, DARZALEX + bortezomib + melphalan + prednisone; TEAE, treatment-emergent adverse event; VMP, bortezomib + melphalan + prednisone

DARZALEX FASPRO in Combination with Lenalidomide

AURIGA (MMY3021; NCT03901963) is an ongoing, open-label, active-controlled, multicenter, randomized, phase 3 study evaluating the conversion rate to MRD-negativity after maintenance treatment with D-R vs R alone in patients with NDMM who are anti-CD 38 naïve, have ≥VGPR, and are MRD-positive after ASCT.25-27 Badros et al (2024)25,26 reported primary results from the phase 3 AURIGA study.

Results - Safety - Infections


Most Commona Nonhematological Infection-Related AEs in the Safety Population25
AE, n (%)
D-R (n=96)
R (n=98)
Any Grade
Grade 3/4
Any Grade
Grade 3/4
Upper respiratory tract infection
40 (41.7)
0 (0)
26 (26.5)
0 (0)
COVID-19
28 (29.2)
1 (1)
29 (29.6)
3 (3.1)
Pneumonia
10 (10.4)
5 (5.2)
14 (14.3)
4 (4.1)
Abbreviations: AE, adverse event; COVID-19, coronavirus disease 2019; D-R, DARZALEX FASPRO + lenalidomide; R, lenalidomide.
aAEs of any grade that occurred in ≥20% of patients and grade 3/4 AEs that occurred in ≥5% of patients in either treatment group.

Clinically Relevant Subgroup Analysis - Phase 3 AURIGA Study

Foster et al (2024)29 presented a post hoc analysis of the phase 3 AURIGA study that evaluated clinically relevant subgroups at a median follow-up of 32.3 months. The clinically relevant subgroups included elderly and black patients, patients with high-risk disease per ISS disease staging, and patients with a high cytogenetic risk per standard, revised, and IMS 2024 high-risk criteria.

Results - Safety - Infection-Related Events

  • No unexpected safety concerns were observed in patients aged ≥65 years or in Black patients.29
  • D-R maintenance did not increase grade 3/4 infection rates in patients ≥65 years of age.29

Infection-Related Safety Results Based on Age for Patients With ≥1 TEAE29
Patients with ≥1 TEAE, n (%)
D-R
R
<65 Years
(n=59)

≥65 Years
(n=37)

<65 Years
(n=58)

≥65 Years
(n=40)

Grade 3/4 TEAEs
45 (76.3)
26 (70.3)
37 (63.8)
29 (72.5)
   Most commona
      Pneumonia
1 (1.7)
4 (10.8)
1 (1.7)
3 (7.5)
Grade 3/4 infections
11 (18.6)
7 (18.9)
6 (10.3)
7 (17.5)
COVID-19 events
   Any grade
19 (32.2)
9 (24.3)
22 (37.9)
7 (17.5)
   Grade 3/4
1 (1.7)
0 (0)
3 (5.2)
0 (0)
Abbreviations: COVID-19, coronavirus disease 2019; D-R, DARZALEX FASPRO + lenalidomide; R, lenalidomide; TEAE, treatment-emergent adverse event.
aOccurring in ≥10% of patients in either treatment group in either age category.


Infection-Related Safety Results Based on Race for Patients With ≥1 TEAE29
Patients with ≥1 TEAE, n (%)
D-R
R
White
(n=64)

Black
(n=20)

White
(n=65)

Black
(n=24)

Grade 3/4 infections
13 (20.3)
4 (20)
8 (12.3)
5 (20.8)
COVID-19 events
   Any grade
18 (28.1)
7 (35)
20 (30.8)
5 (20.8)
   Grade 3/4
1 (1.6)
0 (0)
1 (1.5)
2 (8.3)
Abbreviations: COVID-19, coronavirus disease 2019; D-R, DARZALEX FASPRO + lenalidomide; R, lenalidomide; TEAE, treatment-emergent adverse event.

CEPHEUS (MMY3019; NCT03652064) is an ongoing, randomized, open-label, multicenter, phase 3 study evaluating the efficacy and safety of D-VRd vs VRd in patients with NDMM who are transplant ineligible (TIE) or for whom transplant is not planned as initial therapy (transplant deferred).30-32 Usmani et al (2025)32 reported results from the phase 3 CEPHEUS study.

Results - Safety - Infections

  • The safety data were consistent with the established safety profile of each individual drug.32 Infection-related nonhematologic TEAEs in the safety population are summarized in Table: Infection-Related Nonhematologic TEAEs in the Safety Population.
    • Overall, deaths were reported in 51 vs 60 patients from the D-VRd vs VRd arm, respectively.
      • The COVID-19 pandemic impacted overall survival (OS) with 24 (21.6%) of all deaths in the study attributed to COVID-19 (D-VRd, n=15 vs VRd, n=9).
      • Overall, 21 COVID-19 deaths occurred during the peak of the pandemic in 2020 and 2021, with 3 additional deaths in 2022 (post-vaccine availability), and none in 2023 or 2024.
      • Regional variations were observed in pandemic impact. Brazil reported 54.2% of COVID-19 deaths (17.5% of the study population), while Poland had 16.7% of deaths (18.7% of the study population).
      • Two sensitivity analyses of OS adjusting for COVID-19 deaths showed a stronger treatment effect for D-VRd vs VRd (censoring COVID-19 deaths: hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.45-1.05] and considering COVID-19 deaths as a competing risk [HR for non-COVID mortality, 0.67; 95% CI, 0.44-1.03]).
    • Grade 5 non-COVID-related TEAEs occurred in 10.7% vs 7.7% of patients from the D-VRd vs VRd arm, respectively.
    • Serious TEAEs occurred in 142 (72.1%) vs 131 (67.2%) of patients from the D-VRd vs VRd arm, respectively, with the most common serious TEAE being pneumonia (D-VRd, 13.7%; VRd, 12.8%). A summary of the serious TEAEs is presented in Table: Infection-Related Serious TEAEs (≥2%) in the Safety Population.

Infection-Related Nonhematologic TEAEs in the Safety Populationa,32
TEAE, n (%)
D-VRd (n=197)
VRd (n=195)
Any Grade
Grade 3/4
Any Grade
Grade 3/4
Infections
181 (91.9)
79 (40.1)
167 (85.6)
62 (31.8)
   Upper respiratory tract infection
78 (39.6)
1 (0.5)
64 (32.8)
1 (0.5)
   COVID-19
75 (38.1)
22 (11.2)
48 (24.6)
9 (4.6)
   Pneumonia
48 (24.4)
28 (14.2)
39 (20)
25 (12.8)
   Urinary tract
41 (20.8)
7 (3.6)
29 (14.9)
5 (2.6)
Abbreviations: AE, adverse event; COVID-19, coronavirus disease 2019; D-VRd, DARZALEX FASPRO + bortezomib + lenalidomide + dexamethasone; TEAE, treatment-emergent adverse event; VRd, bortezomib + lenalidomide + dexamethasone.
aThe safety population included patients who received ≥1 dose of the study treatment. AEs of any grade that were reported in ≥20% of patients in either treatment arm and grade 3/4 AEs that were reported in ≥10% of patients in either treatment arm are listed.


Infection-Related Serious TEAEs (≥2%) in the Safety Populationa,32
TEAE, n (%)
D-VRd (n=197)
VRd (n=195)
Serious TEAEs
142 (72.1)
131 (67.2)
   Infections
78 (39.6)
69 (35.4)
      Pneumonia
27 (13.7)
25 (12.8)
      COVID-19
22 (11.2)
16 (8.2)
      COVID-19 pneumonia
8 (4.1)
4 (2.1)
      Sepsis
7 (3.6)
4 (2.1)
      Urinary tract infection
7 (3.6)
4 (2.1)
      Septic shock
6 (3 )
1 (0.5)
      Gastroenteritis
4 (2)
4 (2.1)
      Influenza
4 (2)
1 (0.5)
Abbreviations: COVID-19, coronavirus disease 2019; D-VRd, DARZALEX FASPRO + bortezomib + lenalidomide + dexamethasone; TEAE, treatment-emergent adverse event; VRd, bortezomib + lenalidomide + dexamethasone.
aThe safety population included patients who received ≥1 dose of study treatment.

Literature Search

A literature search of MEDLINE®, Embase®, BIOSIS Previews®, and Derwent Drug File (and/or other resources, including internal/external databases) was conducted on 13 June 2025. For streamlining purposes, retrospective-analyses, systematic reviews, review articles, and case reports have been excluded.

In response to your specific request, summarized in this response is the relevant data from company-sponsored studies pertaining to this topic.

 

References

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17 Sonneveld P, Dimopoulos MA, Boccadoro M, et al. Daratumumab, bortezomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2024;390(4):301-313.  
18 Costa LJ, Chhabra S, Medvedova E, et al. Minimal residual disease response-adapted therapy in newly diagnosed multiple myeloma (MASTER): final report of the multicentre, single-arm, phase 2 trial. Lancet Haematol. 2023;10(11):e890-e901.  
19 Rodriguez-Otero P, Voorhees PM, Boccadoro M, et al. Daratumumab plus bortezomib, lenalidomide, and dexamethasone in transplant-eligible patients with multiple myeloma: a pooled analysis of patients aged ≥65 years from both PERSEUS and GRIFFIN studies. Poster presented at: The 21st International Myeloma Society (IMS) Annual Meeting; September 25-28, 2024; Rio de Janeiro, Brazil.  
20 Facon T, Kumar S, Plesner T, et al. Daratumumab plus lenalidomide and dexamethasone for untreated myeloma. N Engl J Med. 2019;380(22):2104-2115.  
21 Facon T, Kumar SK, Orlowski R, et al. Final survival analysis of daratumumab plus lenalidomide and dexamethasone versus lenalidomide and dexamethasone in transplant-ineligible patients with newly diagnosed multiple myeloma: MAIA study. Poster presented at: The European Hematology Association (EHA) Hybrid Congress; June 13-16, 2024; Madrid, Spain.  
22 Facon T, Moreau P, Weisel K, et al. Daratumumab/lenalidomide/dexamethasone in transplant-ineligible newly diagnosed myeloma: MAIA long-term outcomes. Leukemia. 2025;39(4):942-950.  
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24 Mateos MV, San-Miguel J, Cavo M, et al. Bortezomib, melphalan, and prednisone with or without daratumumab in transplant-ineligible patients with newly diagnosed multiple myeloma (ALCYONE): final analysis of an open-label, randomised, multicentre, phase 3 trial. Lancet Oncol. 2025;26(5):596-608.  
25 Badros A, Foster L, Anderson LD Jr, et al. Daratumumab with lenalidomide as maintenance after transplant in newly diagnosed multiple myeloma: the AURIGA study. Blood. 2025;145(3):300-310.  
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29 Foster L, Anderson LD Jr, Chung A, et al. Daratumumab plus lenalidomide (D-R) versus lenalidomide (R) alone as maintenance therapy in newly diagnosed multiple myeloma (NDMM) after transplant: analysis of the phase 3 AURIGA study among clinically relevant subgroups. Oral Presentation presented at: The 66th American Society of Hematology (ASH) Annual Meeting and Exposition; December 7-10, 2024; San Diego, CA.  
30 Zweegman S, Usmani S, Chastian K, et al. Bortezomib, lenalidomide, and dexamethasone (VRd) ± daratumumab in patients with newly diagnosed multiple myeloma for whom transplant is not planned as initial therapy: a multicenter, randomized, phase 3 study (CEPHEUS). Poster presented at: The Annual Meeting of the American Society of Clinical Oncology (ASCO). May 31-June 4, 2019; Chicago, IL.  
31 Janssen Research & Development, LLC. A study comparing daratumumab, velcade (bortezomib), lenalidomide, and dexamethasone (D-VRd) with velcade, lenalidomide, and dexamethasone (VRd) in participants with untreated multiple myeloma and for whom hematopoietic stem cell transplant is not planned as initial therapy. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2025 June 13]. Available from: https://clinicaltrials.gov/ct2/show/NCT03652064 NML Identifier: NCT03652064.  
32 Usmani SZ, Facon T, Hungria V, et al. Daratumumab plus bortezomib, lenalidomide and dexamethasone for transplant-ineligible or transplant-deferred newly diagnosed multiple myeloma: the randomized phase 3 CEPHEUS study. Nat Med. 2025;31(4):1195-1202.  
33 Zweegman S, Usmani SZ, Hungria V, et al. The phase 3 CEPHEUS trial of daratumumab plus bortezomib, lenalidomide, and dexamethasone in patients with transplant-ineligible or transplant-deferred newly diagnosed multiple myeloma: frailty subgroup analysis. Oral Presentation presented at: The 6th European Myeloma Network (EMN) Meeting; April 10-12, 2025; Athens, Greece.  
34 Facon T, Zweegman S, Hungria V, et al. Daratumumab plus bortezomib, lenalidomide, and dexamethasone (DVRd) in patients with newly diagnosed multiple myeloma (NDMM): Subgroup analysis of transplant-ineligible (TIE) patients in the phase 3 CEPHEUS study. Oral Presentation presented at: The American Society of Clinical Oncology (ASCO) Annual Meeting; May 30-June 3, 2025; Chicago, USA.  
35 Tai M, Ammann E, Kaila S, et al. Use of anti-infective prophylaxis in newly diagnosed and relapsed/refractory multiple myeloma patients initiating treatment with daratumumab. Oral presentation presented at: Virtual 62nd Annual American Society of Hematology (ASH) Meeting & Exposition; December 5-8, 2020.  
36 van de Donk NWCJ, Zweegman S, San-Miguel JF, et al. Predictive markers of high-grade or serious treatment-emergent infections with daratumumab-based regimens in newly diagnosed multiple myeloma (NDMM). Blood. 2020;136(1):10-11.  
37 Moreau P, Attal M, Hulin C, et al. Supplement to: Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study. Lancet. 2019;394:29-38.  
38 Sonneveld P, Dimopoulos MA, Boccadoro M, et al. Supplement to: Daratumumab, bortezomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2023.  
39 Kumar SK, Moreau P, Bahlis N, et al. Daratumumab plus lenalidomide and dexamethasone (D-Rd) versus lenalidomide and dexamethasone (Rd) alone in transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM): updated analysis of the phase 3 MAIA study. Poster presented at: The 64th American Society of Hematology (ASH) Annual Meeting & Exposition; December 10-13, 2022; New Orleans, LA.  
40 Mateos M, San-Miguel J, Cavo M, et al. Supplement to: Bortezomib, melphalan, and prednisone with or without daratumumab in transplant-ineligible patients with newly diagnosed multiple myeloma (ALCYONE): final analysis of an open-label, randomised, multicentre, phase 3 trial. Lancet Oncol. 2025;26(5):596-608.  
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