Comparative Efficacy of Daratumumab Based Regimens in Patients With Relapsed‐Refractory Multiple Myeloma ( RRMM ) Aged 70 and Above: A Multicenter Study

BACKGROUND: Patients aged ≥ 70 years with relapsed/refractory multiple myeloma (RRMM) face unique challenges due to physiological changes and increased toxicity from treatments. Daratumumab-based regimens have shown efficacy, but direct comparisons in elderly populations are lacking. METHODS: A multicenter retrospective study compared daratumumab, pomalidomide, and dexamethasone (DPd) to daratumumab, carfilzomib, and dexamethasone (DKd) in patients with RRMM aged ≥ 70 years. The primary endpoint was progression-free survival (PFS), with secondary endpoints including overall survival (OS) and response rates. RESULTS: The study included 150 patients (119 DPd, 31 DKd). Baseline characteristics were similar, but DPd had more lenalidomide-refractory patients (90% vs. 74%, p = 0.035). Overall response rates were comparable (DPd 77%, DKd 74.5%, p = 0.8), but DKd had a significantly higher rate of deep responses (64.5% vs. 36%, p < 0.01). Median PFS was 12 months for DPd and 13 months for DKd (p = 0.6); median OS was 50 months for DPd and 28 months for DKd (p = 0.2). Multivariate analysis identified poor performance status and high-risk cytogenetics as adverse prognostic factors. CONCLUSION: DPd and DKd showed similar efficacy for elderly RRMM patients, with DKd achieving deeper responses. Treatment decisions should consider individual patient factors rather than focusing solely on efficacy differences.