Indirect treatment comparison of DVRd plus DR maintenance (PERSEUS study) versus DVTd or VTd with or without lenalidomide maintenance in transplant-eligible patients with previously untreated multiple myeloma.

In 30 seconds

This indirect treatment comparison assessed progression-free survival with DVRd induction and consolidation followed by daratumumab–lenalidomide maintenance (DR) versus VTd or DVTd regimens, with observation or lenalidomide maintenance, in transplant-eligible patients with newly diagnosed multiple myeloma. Individual patient data from PERSEUS and CASSIOPEIA were adjusted using weighting methods, with Myeloma XI data also used to model lenalidomide maintenance outcomes. DVRd plus DR was associated with longer progression-free survival across all four comparisons; versus DVTd plus observation, the hazard ratio was 0.39 (95% CI = 0.26-0.59).

Key findings

• DVRd plus DR had superior progression-free survival versus DVTd plus observation (hazard ratio, 0.39 [95% CI = 0.26-0.59]).
• Progression-free survival favored DVRd plus DR versus VTd plus observation (hazard ratio, 0.17 [95% CI = 0.12-0.25]).
• DVRd plus DR also favored progression-free survival versus DVTd plus lenalidomide (0.62 [95% CI = 0.41-0.92]) and VTd plus lenalidomide (0.29 [95% CI = 0.18-0.43]).

Why it matters

The comparison addresses whether a daratumumab-containing quadruplet followed by dual-agent maintenance may improve disease control relative to commonly used induction and maintenance approaches in transplant-eligible newly diagnosed myeloma. Its results provide comparative evidence across regimens, while the indirect design means the estimates should be interpreted with attention to differences between the contributing trials.

What to keep in mind

The comparison was unanchored because there were no common comparators, used external Myeloma XI data to model lenalidomide maintenance outcomes, and may retain residual confounding despite adjustment for treatment effect modifiers.