Therapeutic Advances in Hematology (Dec 2022)

Monocyte or white blood cell counts and β microglobulin predict the durable efficacy of daratumumab with lenalidomide

  • Yutaka Shimazu,
  • Junya Kanda,
  • Hitomi Kaneko,
  • Kazunori Imada,
  • Ryosuke Yamamura,
  • Satoru Kosugi,
  • Yuji Shimura,
  • Tomoki Ito,
  • Shin-ichi Fuchida,
  • Hitoji Uchiyama,
  • Kentaro Fukushima,
  • Satoshi Yoshihara,
  • Hitoshi Hanamoto,
  • Hirokazu Tanaka,
  • Nobuhiko Uoshima,
  • Kensuke Ohta,
  • Hideo Yagi,
  • Hirohiko Shibayama,
  • Yoshiyuki Onda,
  • Yasuhiro Tanaka,
  • Yoko Adachi,
  • Mitsuhiro Matsuda,
  • Masato Iida,
  • Takashi Miyoshi,
  • Toshimitsu Matsui,
  • Ryoichi Takahashi,
  • Teruhito Takakuwa,
  • Masayuki Hino,
  • Naoki Hosen,
  • Shosaku Nomura,
  • Chihiro Shimazaki,
  • Itaru Matsumura,
  • Akifumi Takaori-Kondo,
  • Junya Kuroda,

DOI
https://doi.org/10.1177/20406207221142487
Journal volume & issue
Vol. 13

Abstract

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Background: Daratumumab is one of the most widely used treatments for relapsed/refractory multiple myeloma (MM) patients. However, not all patients achieve a lasting therapeutic response with daratumumab. Objectives: We hypothesized that a durable response to daratumumab could be predicted by the balance between the MM tumor burden and host immune status. Design: We conducted a retrospective study using the real-world data in the Kansai Myeloma Forum (KMF) database. Methods: We retrospectively analyzed 324 relapsed/refractory MM patients who were treated with daratumumab in the KMF database. Results: In this study, 196 patients were treated with daratumumab, lenalidomide, and dexamethasone (DLd) regimen and 128 patients were treated with daratumumab, bortezomib, and dexamethasone (DBd) regimen. The median age at treatment, number of prior treatment regimens and time-to-next-treatment (TTNT) were 68, 4 and 8.02 months, respectively. A multivariate analysis showed that the TTNT under the DLd regimen was longer with either higher monocyte counts (analysis 1), higher white blood cell (WBC) counts (analysis 2), lower β 2 microglobulin (B2MG < 5.5 mg/L) or fewer prior regimens (<4). No parameters were correlated with TTNT under the DBd regimen. Conclusion: We propose a simple scoring model to predict a durable effect of the DLd regimen by classifying patients into three categories based on either monocyte counts (0 points for ⩾200/μl; 1 point for <200/μl) or WBC counts (0 points for ⩾3500/μl; 1 point for <3500/μl) plus B2MG (0 points for <5.5 mg/L; 1 point for ⩾5.5 mg/L). Patients with a score of 0 showed significantly longer TTNT and significantly better survival compared to those with a score of 1 or 2 (both p < 0.001). To confirm this concept, our results will need to be validated in other cohorts.