AURIGA: A post hoc analysis of post-transplant D-R maintenance in NDMM

A post hoc analysis from the phase III AURIGA trial (NCT03901963), published by Foster et al. in the Blood Cancer Journal, investigated the efficacy and safety of daratumumab + lenalidomide (D-R) maintenance (n = 99) vs R monotherapy (n = 101) in transplant-eligible patients with newly diagnosed multiple myeloma (NDMM). The analysis focused on clinically relevant subgroups, including those with high-risk cytogenetic abnormalities (HRCAs). The primary endpoint was the rate of measurable residual disease (MRD) negativity, at a sensitivity of 10^–5 by 12 months post maintenance therapy.

Key data: MRD negative conversion rates were higher with D-R vs R across high-risk subgroups as per the original (31.8% vs 6.7%), revised (43.8% vs 13.3%), and modified IMS 2024 (41.2% vs 0%) criteria, as well as cytogenetically ultra-high-risk disease with ≥2 revised HRCAs (54.5% vs 0%). Progression-free survival (PFS) was consistently prolonged with D-R vs R across all subgroups. 

Key learning: D-R maintenance demonstrates consistent clinical benefit across patient subgroups with transplant-eligible NDMM, regardless of age or race, supporting its use in all transplant-eligible patients with NDMM.