Peter Voorhees, MD: Let’s go on and talk about available treatment options for patients with a transplant-eligible newly diagnosed myeloma. Reed, what induction strategies are you thinking about when you’re discussing treatment in your newly diagnosed patients?

Reed Friend, MD: In terms of newly diagnosed, obviously, I first think about is this patient transplant eligible or ineligible? If [the patient is] transplant eligible, there are really great data out from GRIFFIN [NCT02874742]. Thinking of doing quad therapy, so daratumumab, Revlimid, Velcade, and dexamethasone in the upfront setting. And I think in our practice, we generally will start with that.

Peter Voorhees, MD: Yes. Kwabena, do you have any thoughts about the use of a 3-drug treatment strategy versus a 4-drug treatment strategy for those patients who are transplant eligible with newly diagnosed myeloma?

Kwabena Osei-Boateng, MD: Yeah, I think I agree with Reed that for patients, barring comorbidities and things that would preclude a 4-drug regimen, the data is quite strong based on the GRIFFIN trial for the quad regimen in terms of MRD [minimal residual disease] negativity, which confers PFS benefit. So, I tend to go with the quad regimen.

Peter Voorhees, MD: And when we initially published those results, we did show that improved depth of response with the addition of daratumumab into the RVd [lenalidomide, bortezomib, and dexamethasone] backbone. But more recently, and this was presented at the International Myeloma Society meeting last year, we did see that progression-free survival advantage, as well. So, at the 4-year mark, progression-free survival for those patients receiving the quadruplet was 87.5% versus 70% for those who got the triplet. So, that improvement in depth of response is starting to translate into an improvement in progression-free survival, as well. And hopefully that manuscript will be published in the very near future.

Amy, do you have any strong feelings about choice of a proteasome inhibitor in patients who are transplant eligible with newly diagnosed multiple myeloma? Are there specific instances where you might use carfilzomib in the place of bortezomib as your proteasome inhibitor?

Amy Soni, MD: Before I was using daratumumab more, it was more of a consideration. But [for] those with high-risk myeloma FISH [fluorescence in situ hybridization] panels, I would consider it.

Peter Voorhees, MD: Yeah, I would agree with that. You know, unfortunately, there’s no head-to-head comparative data between a carfilzomib-based strategy versus a bortezomib-based strategy for newly diagnosed patients, except in a nontransplant setting, in patients with standard-risk cytogenetic features. So, we don’t have head-to-head comparison in those patients with high risk of genetic features. But in these single-arm, phase 2 studies, daratumumab, carfilzomib, len[alidomide], dex[amethasone], for example, has performed incredibly well in patients with both standard-risk and high-risk myeloma. We’ll talk a little bit about more of that in a moment. The other patient population where I would consider using carfilzomib in the place of bortezomib is somebody who has preexisting neuropathy. That would make bortezomib difficult to manage in the frontline setting.

Transcript is AI-generated and edited for clarity and readability.