Stem Cell Yield Adequate for Transplant After 4 Cycles of Daratumumab, Lenalidomide Quadruplet Induction for MM

Four cycles of daratumumab and lenalidomide quadruplet induction therapy had no major effect on stem cell yield in adults with newly diagnosed multiple myeloma (MM), according to a study published in Transplantation and Cellular Therapy.

“For eligible patients with newly diagnosed MM, standard of care includes induction therapy followed by autologous stem cell transplant…,” explained corresponding author Saurabh Chhabra, MD, of the Mayo Clinic Arizona in Phoenix, and coauthors in the study background. “However, there is concern that lenalidomide and daratumumab given as induction therapy may impair mobilization of stem cells for autologous stem cell transplant. We therefore assessed stem cell mobilization yields in patients following frontline induction therapy in the phase 2 clinical studies MASTER and GRIFFIN.”

In the single-arm MASTER trial, patients received induction therapy consisting of daratumumab plus carfilzomib/lenalidomide/dexamethasone (D-KRd) for four 28-day cycles. In the randomized GRIFFIN trial, patients received lenalidomide/bortezomib/dexamethasone (RVd) ± daratumumab (D) for four 21-day cycles. In both studies, stem cell mobilization and autologous stem cell transplant followed.

In the first mobilization attempt, minimally required CD34+ cell yields went unmet by 7% of patients who received D-KRd, 2% of patients who received D-RVd, and 6% of patients who received RVd. Nevertheless, upon remobilization nearly all patients collected sufficient stem cells for autologous stem cell transplant, according to the study.

The use of plerixafor as an upfront or rescue strategy for stem cell mobilization occurred in 97% in patients who received D-KRd, 72% of patients who received D-RVd , and 55% of patients who received RVd.

“Among patients who underwent mobilization,” researchers reported, “98% (114/116) of D-KRd patients, 99% (94/95) of D-RVd patients, and 98% (78/80) RVd patients underwent autologous stem cell transplant using a median CD34+ cell dose of 3.2 × 106/kg, 4.2 × 106/kg, and 4.8 × 106/kg respectively.”

Reference:
Chhabra S, Callander N, Watts NL, et al. Stem cell mobilization yields with daratumumab and lenalidomide-containing quadruplet induction therapy in newly diagnosed multiple myeloma: findings from the MASTER and GRIFFIN trials. Transplant Cell Ther. Published online December 6, 2022. doi:10.1016/j.jtct.2022.11.029