Impact of Self-Identified Race on Outcomes in Newly Diagnosed Multiple Myeloma (NDMM) Patients Receiving Induction Therapy with Daratumumab, Lenalidomide, Bortezomib and Dexamethasone (D-RVd)
Authors: Joseph Nisha S. , Gupta Shruti , Kaufman Jonathan L. , Dicamillo Sara , Roberts Danielle , Gupta Vikas A. , Hofmeister Craig C. , Dhodapkar Madhav V. , Lonial Sagar , Nooka Ajay K. 
Published: December 2024

Introduction: Following the results of the phase 3 PERSEUS trial, the addition of daratumumab to RVD (D-RVd) has become standard of care with improved depth of response and PFS benefit. We have previously presented data from our institutional database of 326 patients induced with D-RVd consistent with the clinical trial findings of improved efficacy over RVd alone. Here, we present subgroup analysis on outcomes of white and black newly diagnosed myeloma (NDMM) patients induced with D-RVd.
Methods: 326 NDMM patients treated with D-RVd induction therapy from April 2018 - August 2022 were included in this analysis. Following induction, patients underwent stem cell transplant and risk-stratified maintenance therapy. Demographic and clinical characteristics and outcomes data were obtained from our institutional review board-approved myeloma database and with manual abstraction. Responses and progression were evaluated per International Myeloma Working Group Uniform Response Criteria.
Results: For the overall cohort, the median age was 62.1(23.5-79.3) and 55.5% are male. 55.1% white, 40.9% black, 2.8% Asian, and 0.3% American Indian/Alaskan Native. 3.7% of patients identified as Hispanic. For black patients, the median age was 59 compared to 64 for white patients. Laboratory values at diagnosis were similar between the groups except for hemoglobin which was lower in blacks than whites (Hgb 10.2 g/dL vs 11.7 g/dL, p =0.003) Other notable characteristics include: ISS 3 20.2%, R-ISS 3 6.1%, and 13.8% high risk by CTG. There was no statistically significant difference between white and black patients in regards to notable cytogenetic features- t(11;14): 23% v 19%; t(4;14): 2.0% v 5.8%; t(14;16): 0.7% v 0%; del(17p): 3.3% v 9.1%; t(14;20): 0.7% v 2.5%; +1q21: 25.2% v 23.1%; complex karyotype: 8.4% v 7.6%. There was also no significant difference between white and black patients in terms of presence of extramedullary disease, ISS, R-ISS, or high-risk classification by cytogenetics. For the overall cohort, the ORR and ≥VGPR are 99.6% and 86.5% post-induction and 99.3% and 95.6% post-transplant. Post-induction response rates for white and black patients: ORR 99.4% v 99.2%, ≥VGPR 87.3% v 85.6%, ≥CR 22% v 18.9%. Post-transplant response rates: ORR 98.3% v 94.7%, ≥VGPR 81% v 78%, ≥CR 34.1% v 35.6%. With a median follow up of 33.2 months, the median PFS for white and black patients is 73.9 months v 58 months (p = 0.223) Median overall survival (OS) was not reached for either group.
Conclusions: D-RVd is a safe and effective induction regimen in both black and white patients. Comparatively, black patients are more likely to be diagnosed at a younger age and are more likely to be anemic at diagnosis. There were no other statistically significant differences between white and black patients in terms of high-risk features, response rates or survival outcomes to date. This data provides further insight into the importance of adequate access to care for all patients to ensure equitable outcomes.