Blood Res.  2023 Jun;58(2):83-90. 10.5045/br.2023.2023005.

Advantage of achieving deep response following frontline daratumumab-VTd compared to VRd in transplant-eligible multiple myeloma: multicenter study

  • 1Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 3Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 4Department of Hematology, Yeoido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 5Department of Hematology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 6Department of Hematology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea


The goal of induction therapy for multiple myeloma (MM) is to achieve adequate disease control. Current guidelines favor triplet (bortezomib-lenalidomide-dexamethasone; VRd) or quadruplet regimens (daratumumab, bortezomib-thalidomide-dexamethasone; D-VTd). In the absence of a direct comparison between two treatment regimens, we conducted this study to compare the outcomes and safety of VRd and D-VTd.
Newly diagnosed MM patients aged >18 years who underwent induction therapy followed by autologous stem cell transplantation (ASCT) between November 2020 and December 2021 were identified. Finally, patients with VRd (N=37) and those with D-VTd (N=43) were enrolled.
After induction, 10.8% of the VRd group showed stringent complete remission (sCR), 21.6% showed complete response (CR), 35.1% showed very good partial response (VGPR), and 32.4% showed partial response (PR). Of the D-VTd group, 9.3% showed sCR, 34.9% CR, 48.8% VGPR, and 4.2% PR (VGPR or better: 67.6% in VRd vs. 93% in D-VTd, P =0.004). After ASCT, 68.6% of the VRd group showed CR or sCR, while 90.5% of the D-VTd group showed CR or sCR (P=0.016). VRd was associated with an increased incidence of skin rash (P=0.044). Other than rashes, there were no significant differences in terms of adverse events between the two groups.
Our study supports the use of a front-line quadruplet induction regimen containing a CD38 monoclonal antibody for transplant-eligible patients with newly diagnosed MM.


Transplant-eligible; Newly diagnosed; Quadruplet; Triplet; Multiple myeloma


  • Fig. 1 Study flow.

  • Fig. 2 Summary of responses and subgroup analysis (A) response throughout the treatment, *VGPR or better rate post induction, 67.6 % vs. 93% (P=0.004); **CR or better rate post ASCT, 68.6% vs. 90.5% (P=0.016); ***MRD negativity at 100 days post ASCT, 66.7% vs. 94.4%, P=0.046, respectively (B) change in response, (C) progression free survival. Abbreviations: ASCT, autologous stem cell transplantation; CR, complete response; D-VTd, daratumumab-bortezomib-thalidomide-dexame-thasone; MRD, minimal residual disease; PD, progressive disease; PR, partial response; sCR, stringent complete response; VGPR, very good partial response; VRD, bortezomib-lenalidomide-dexam-ethasone.

  • Fig. 3 Daratumumab dose intensity per cycle.


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