Multiple Myeloma
Conditions
Brief summary
The purpose of this study is to determine if the addition of daratumumab to lenalidomide-bortezomib-dexamethasone (RVd) will increase the proportion of participants achieving stringent complete response (sCR), as defined by the International Myeloma Working Group (IMWG) criteria, by the time of completion of post autologous stem cell transplantation (ASCT) consolidation treatment, compared with RVd alone.
Interventions
Cycles 1 through 6: lenalidomide 25 (milligram) mg orally on Days 1 through 14 and each cycle is of 21-days followed by maintenance treatment with lenalidomide 10 mg on days 1-21 throughout each 28-day cycle on Cycles 7 through 9. Beginning at Cycle 10, the lenalidomide dose will be increased to 15 mg unless there is a tolerability concern.
Bortezomib 1.3 mg/m\^2 subcutaneously on Days 1, 4, 8, and 11 during Cycles 1-6.
Dexamethasone 40 mg orally every week (20 mg on Days 1, 2, 8, 9, 15, and 16).
Daratumumab intravenously at a dose of 16 milligram per kilogram (mg/kg) weekly during induction treatment (Days 1, 8, and 15 of Cycles 1 through 4), and every 3 weeks during consolidation treatment (Day 1 of Cycles 5 and 6), followed by maintenance treatment with daratumumab every 4 or 8 weeks.
Sponsors
Study design
Eligibility
Inclusion criteria
* Considered by the investigator to be eligible for high-dose chemotherapy (HDT) and autologous stem cell transplantation (ASCT) according to the institution's criteria based on age, medical history, cardiac and pulmonary status, overall health and condition, co-morbid condition(s), physical examination, and laboratory studies * Has not had prior systemic therapy for multiple myeloma. An emergency course of steroids (defined as no greater than 40 milligram \[mg\] of dexamethasone, or equivalent per day for a maximum of 4 days (that is, a total of 160 mg) is permitted. In addition, radiation therapy is permitted prior to study entry, during screening, and during Cycles 1-2 of study treatment as needed for lytic bone disease * Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1, or 2 * Woman of childbearing potential must have 2 negative highly sensitive serum (beta-human chorionic gonadotropin \[b-hCG\]) during screening, the first one within 10 to 14 days prior to the first dose of any component of study treatment and the second within 24 hours prior to the first dose of any component of study treatment * A woman must agree not to donate eggs (ova, oocytes) for the purposes of assisted reproduction during the study (including during dose interruptions), and for 4 weeks following discontinuation of lenalidomide, and if receiving daratumumab, for 3 months after the last dose
Exclusion criteria
* Diagnosed or treated for malignancy other than multiple myeloma, except: a) Malignancy treated with curative intent and with no known active disease present for more than equal to (\>= )3 years before randomization; b) Adequately treated non-melanoma skin cancer, lentigo maligna or in situ malignancies (including but not limited to, cervical, breast) with no evidence of disease * Exhibiting clinical signs of or has a known history of meningeal or central nervous system involvement by multiple myeloma * Known chronic obstructive pulmonary disease with a forced expiratory volume in 1 second (FEV1) less than (\<)50 percent (%) of predicted normal * Known moderate or severe persistent asthma within the past 2 years or currently has uncontrolled asthma of any classification * Known to be seropositive for human immunodeficiency virus, known to have hepatitis B surface antigen positivity, or known to have a history of hepatitis C. Participants who completed treatment for hepatitis C at least 6 months prior to screening and have no detectable circulating hepatitis C virus (HCV) at screening, may participate in the study. Such participants will be required to undergo regular assessment for HCV reactivation during their participation in the study. Participants who test positive for HCV at any time during these assessments will be withdrawn from the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Stringent Complete Response (sCR) | From randomization to post-ASCT consolidation (after Cycle 6) before maintenance treatment (up to 10 months) | Percentage of participants who had achieved sCR as determined by the validated computer algorithm according to the International Myeloma Working Group (IMWG) criteria, by the end of post-autologous stem cell transplantation (post-ASCT) consolidation treatment were reported. Complete response (CR) is defined as negative immunofixation on the serum and urine, and disappearance of any soft tissue plasmacytomas, and less than (\<) 5 percent (%) PCs in bone marrow. sCR is defined as in addition to CR a normal FLC ratio, and absence of clonal plasma cells (PCs) by immunohistochemistry or immunofluorescence or 2 to 4-color flow cytometry. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Overall Stringent Complete Response (sCR) | From randomization to end of following: induction treatment, ASCT, post-ASCT consolidation (after Cycle 6) and at the end of maintenance treatment of 24 months (overall duration up to 34 months) | Overall sCR rate is defined as the percentage of participants who achieved sCR, according to the IMWG criteria. CR is defined as negative immunofixation on the serum and urine, and disappearance of any soft tissue plasmacytomas, and \< 5 % PCs in bone marrow. sCR is defined as in addition to CR a normal FLC ratio, and absence of clonal PCs by immunohistochemistry or immunofluorescence or 2 to 4-color flow cytometry. |
| Percentage of Participants With Overall Response Rate (ORR) | From randomization to end of following: induction treatment, ASCT, post-ASCT consolidation (after Cycle 6) and at the end of maintenance treatment of 24 months (overall duration up to 34 months) | ORR- percentage of participants who achieved partial response (PR) or better (PR, Very Good Partial Response \[VGPR\], CR or sCR) based on computerized algorithm as per IMWG criteria. PR -greater than or equal to (\>=) 50% reduction of serum M-protein and reduction in 24-hour urinary M-protein by \>=90% or to \<200 mg//24 hours. If serum and urine M-protein are not measurable, a decrease of \>=50% in the difference between involved and uninvolved FLC levels is required. A \>=50% reduction in the size of soft tissue plasmacytomas is also required; VGPR-serum and urine M-component detectable by immunofixation but not on electrophoresis, or \>= 90% reduction in serum M-protein plus urine M-protein \<100 mg/24 hours; CR-negative immunofixation on the serum and urine, and disappearance of any soft tissue plasmacytomas, and \<5% PCs in bone marrow. sCR- in addition to CR a normal FLC ratio, and absence of clonal PCs by immunohistochemistry or immunofluorescence or 2 to 4-color flow cytometry. |
| Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | From randomization to end of following: induction treatment, ASCT, post-ASCT consolidation (after Cycle 6) and at the end of maintenance period of 24 months (overall duration up to 34 months) | VGPR or better rate is defined as the percentage of participants who achieved VGPR or better, according to the IMWG criteria. VGPR is defined as serum and urine M-component detectable by immunofixation but not on electrophoresis, or \>= 90% reduction in serum M-protein plus urine M-protein \<100 mg/24 hours. |
| Percentage of Participants With Negative Minimal Residual Disease (MRD) | From randomization to end of following: induction treatment, post-ASCT consolidation (after Cycle 6) (up to 4.5 months), and at the end of maintenance period of 24 months (overall duration up to 34 months) | Minimal residual disease negative rate is defined as the percentage of participants who achieve MRD negative status by the respective time point. Minimal residual disease was evaluated in participants who achieved CR or sCR (including participants with VGPR or better and suspected daratumumab interference) using next-generation sequencing which utilizes multiple myeloma cell DNA from bone marrow aspirates at a threshold of less than (\<) 10\^5. |
| Duration of Complete Response or Better | From randomization to the date of first documented evidence of progressive disease or relapse from CR (up to 5 years) | Duration of CR or better is the duration from the date of initial documentation of a CR or sCR response, according to the IMWG criteria, to the date of first documented evidence of progressive disease (PR), or relapse from CR. PD is defined as an increase of 25 % from the lowest response value in one of the following: serum and urine M-component (absolute increase must be greater than or equal to \[\>=\] 0.5 gram per deciliter \[g/dL\] and \>=200 milligrams \[mg\]/24 hours respectively); Only in participants without measurable serum and urine M-protein levels the difference between involved and uninvolved FLC levels (absolute increase must be \> 10 mg/dL); Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; Development of hypercalcemia (corrected serum calcium \>11.5 mg/dL) that can be attributed solely to plasma cells (PCs) proliferative disorder. |
| Duration of Stringent Complete Response (sCR) | From randomization to the date of first documented evidence of progressive disease or relapse from sCR (up to 5 years) | Duration of sCR is the duration from the date of initial documentation of a sCR response, according to the IMWG criteria, to the date of first documented evidence of progressive disease, or relapse from sCR. PD is defined as an increase of 25 % from the lowest response value in one of the following: serum and urine M component (absolute increase must be \>= 0.5 g/dL and \>=200 mg/24 hours respectively); Only in participants without measurable serum and urine M-protein levels the difference between involved and uninvolved FLC levels (absolute increase must be \> 10 mg/dL); Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; Development of hypercalcemia (corrected serum calcium \>11.5 mg/dL) that can be attributed solely to PC proliferative disorder. |
| Time to Stringent Complete Response (sCR) | From randomization to the date of initial documentation of sCR (up to 5 years) | Time to sCR is the duration from the date of randomization to the date of initial documentation of sCR, which was confirmed by a repeated measurement as required by the IMWG criteria. |
| Percentage of Participants With Complete Response (CR) or Better | From randomization to end of following: induction treatment, ASCT, post-ASCT consolidation (after Cycle 6) and at the end of maintenance period of 24 months (overall duration up to 34 months) | CR or better rate is defined as the percentage of participants who achieve CR or sCR, according to the IMWG criteria. CR is negative immunofixation on the serum and urine, and disappearance of any soft tissue plasmacytomas, and \< 5% PCs in bone marrow. sCR is defined as in addition to CR a normal FLC ratio, and absence of clonal plasma cells (PCs) by immunohistochemistry or immunofluorescence or 2 to 4-color flow cytometry. For 2 participants (1 in each randomized treatment group), data were updated by the study sites which resulted in their inclusion to the response-evaluable analysis set after the primary analysis. |
| Time to Very Good Partial Response (VGPR) or Better | From randomization to the date of initial documentation of VGPR or better (up to 5 years) | Time to VGPR or better is the duration from the date of randomization to the date of initial documentation of VGPR or better, which was confirmed by a repeated measurement as required by the IMWG criteria. |
| Time to Partial Response (PR) or Better | From randomization to the date of initial documentation of PR or better (up to 5 years) | Time to PR or better is the duration from the date of randomization to the date of initial documentation of PR or better, which was confirmed by a repeated measurement as required by the IMWG criteria. |
| Progression-free Survival (PFS) | From randomization to the date of first documented evidence of progressive disease or death (up to 5 years) | PFS is defined as the duration from the date of randomization to the date of first documented evidence of progressive disease or death, whichever comes first. PD is defined as an increase of 25 % from the lowest response value in one of the following: serum and urine M-component (absolute increase must be \>= 0.5 g/dL and \>=200 mg/24 hours respectively); Only in participants without measurable serum and urine M-protein levels the difference between involved and uninvolved FLC levels (absolute increase must be \> 10 mg/dL); Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; Development of hypercalcemia (corrected serum calcium \>11.5 mg/dL) that can be attributed solely to PC proliferative disorder. |
| Overall Survival (OS) | From randomization to the date of initial documentation of participant's death (up to 5 years) | OS is measured from the date of randomization to the date of the participant's death. |
| Time to Progression (TTP) | From randomization to the date of first documented evidence of progressive disease (up to 5 years) | TTP is defined as the duration from the date of randomization to the date of first documented evidence of progressive disease according to the IMWG criteria. |
| Duration of Response | From the date of initial documentation of a response (PR or better) to the date of first documented evidence of progressive (up to 5 years) | Duration of response is defined as the duration from the date of initial documentation of a response (PR or better) according to the IMWG criteria to the date of first documented evidence of progressive disease according to the IMWG criteria. PD is defined as an increase of 25 % from the lowest response value in one of the following: serum and urine M-component (absolute increase must be \>= 0.5 g/dL and \>=200 mg/24 hours respectively); Only in participants without measurable serum and urine M-protein levels the difference between involved and uninvolved FLC levels (absolute increase must be \> 10 mg/dL); Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; Development of hypercalcemia (corrected serum calcium \>11.5 mg/dL) that can be attributed solely to PC proliferative disorder. |
| Time to Complete Response or Better | From randomization to the date of initial documentation of CR (up to 5 years) | Time to CR or better is the duration from the date of randomization to the date of initial documentation of CR or better, which was confirmed by a repeated measurement as required by the IMWG criteria. |
Countries
United States
Participant flow
Recruitment details
223 participants were enrolled/randomized (16 in safety run-in,104 to D-RVd and 103 to RVd group). Among 207 (D-RVd \[104\]+RVd \[103\]) randomized, 201 received treatment (D-RVd: 100 and RVd: 101). 1 participant randomized to D-RVd group received RVd treatment and was randomized twice (resulting a total of 224 participants).
Pre-assignment details
Participant was a screen-failure but was mistakenly randomized first to D-RVd ; after re-screening was randomized to RVd group. The participant was counted in D-RVd for ITT analysis and RVd for safety analysis. So, safety analysis set included 99 participants in D-RVd and 102 in RVd group who received at least 1 dose of study treatment.
Participants by arm
| Arm | Count |
|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) Induction and Consolidation Phase (12-week induction phase followed by autologous stem cell mobilization, high-dose chemotherapy \[HDT\] and autologous stem cell transplantation \[ASCT\]; 6-week consolidation phase)- participants received lenalidomide 25 milligrams (mg) orally on Days 1 to 14 of Cycles 1 through 6), bortezomib 1.3 mg per meter square (mg/m\^2) subcutaneously (SC) on Days 1, 4, 8, and 11 and dexamethasone 40 mg orally weekly (20 mg on Days 1, 2, 8, 9, 15 and 16); Maintenance phase (up to 104 week \[until disease progression/up to maximum of 2 years\])- participants received lenalidomide 10 mg orally on Days 1 to 21 throughout each 28-day cycle on Cycles 7 through 9 during maintenance treatment. Beginning at Cycle 10, lenalidomide dose was increased to 15 mg, unless there was tolerability concern. After 2 years of maintenance therapy, participants could continue to lenalidomide monotherapy per standard of care. Long-term follow-up phase- all participants were followed for at least 1 year after last dose of study drug and to continue until death, withdrawal of consent or end of study. | 103 |
| Randomized: Daratumumab+RVd (D-RVd) Induction and Consolidation Phase (12 week induction phase followed by autologous stem cell mobilization, HDT and ASCT; a 6-week consolidation phase)-participants received RVd with daratumumab 16 milligrams per kilogram (mg/kg) intravenously (IV) weekly on Days 1, 8, and 15 of Cycles 1 to 4 during induction treatment and every 3 weeks on Day 1 of Cycles 5 and 6 during consolidation treatment; Maintenance phase (up to 104-week \[until disease progression/up to maximum of 2 years\])- participants received daratumumab 16 mg/kg every 4 weeks/8 weeks plus lenalidomide 10 mg orally on Days 1 to 21 throughout each 28-day cycle on Cycles 7 through 9 during maintenance treatment. Beginning at Cycle 10, the lenalidomide dose was increased to 15 mg, unless there was a tolerability concern. After 2 years of maintenance therapy, participants could continue to lenalidomide monotherapy per standard of care. Long-term follow-up phase- all participants were followed for at least 1 year after last dose of study drug and to continue until death, withdrawal of consent or end of study. Per protocol amendment 4, to provide flexibility and prioritize safety during the global coronavirus-19 (COVID-19) pandemic, participants were given the option to switch from daratumumab IV to daratumumab SC at the discretion of the investigator. | 104 |
| Safety Run-in: D-RVd Induction and Consolidation Phase (12 week induction phase followed by autologous stem cell mobilization, HDT and ASCT; a 6-week consolidation phase)-participants received RVd with daratumumab 16 mg/kg IV weekly on Days 1, 8, and 15 of Cycles 1 to 4 during induction treatment and every 3 weeks on Day 1 of Cycles 5 and 6 during consolidation treatment; Maintenance phase (up to 104-week \[until disease progression/up to maximum of 2 years\])- participants received daratumumab 16 mg/kg every 4 weeks/8 weeks plus lenalidomide 10 mg orally on Days 1 to 21 throughout each 28-day cycle on Cycles 7 through 9 during maintenance treatment. Beginning at Cycle 10, the lenalidomide dose was increased to 15 mg, unless there was a tolerability concern. After 2 years of maintenance therapy, participants could continue to lenalidomide monotherapy per standard of care. Long-term follow-up phase- all participants were followed for at least 1 year after last dose of study drug and to continue until death, withdrawal of consent or end of study. | 16 |
| Total | 223 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Death | 0 | 1 | 0 |
| Overall Study | Lost to Follow-up | 5 | 4 | 1 |
| Overall Study | Other | 4 | 1 | 0 |
| Overall Study | Progressive Disease | 1 | 0 | 0 |
| Overall Study | Screen Failure | 0 | 2 | 0 |
| Overall Study | Withdrawal by Subject | 17 | 8 | 0 |
Baseline characteristics
| Characteristic | Total | Safety Run-in: D-RVd | Randomized: Daratumumab+RVd (D-RVd) | Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) |
|---|---|---|---|---|
| Age, Continuous | 58.2 years STANDARD_DEVIATION 8.49 | 59.8 years STANDARD_DEVIATION 5.96 | 57.2 years STANDARD_DEVIATION 9.79 | 59 years STANDARD_DEVIATION 7.27 |
| Race/Ethnicity, Customized American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 3 Participants | 1 Participants | 0 Participants | 2 Participants |
| Race/Ethnicity, Customized Black or African American | 36 Participants | 4 Participants | 14 Participants | 18 Participants |
| Race/Ethnicity, Customized More than one race | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Other | 3 Participants | 0 Participants | 2 Participants | 1 Participants |
| Race/Ethnicity, Customized Unknown or Not Reported | 8 Participants | 0 Participants | 3 Participants | 5 Participants |
| Race/Ethnicity, Customized White | 172 Participants | 11 Participants | 85 Participants | 76 Participants |
| Region of Enrollment UNITED STATES | 223 Participants | 16 Participants | 104 Participants | 103 Participants |
| Sex: Female, Male Female | 97 Participants | 8 Participants | 46 Participants | 43 Participants |
| Sex: Female, Male Male | 126 Participants | 8 Participants | 58 Participants | 60 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 7 / 103 | 7 / 104 | 1 / 16 |
| other Total, other adverse events | 102 / 102 | 99 / 99 | 16 / 16 |
| serious Total, serious adverse events | 53 / 102 | 46 / 99 | 12 / 16 |
Outcome results
Percentage of Participants With Stringent Complete Response (sCR)
Percentage of participants who had achieved sCR as determined by the validated computer algorithm according to the International Myeloma Working Group (IMWG) criteria, by the end of post-autologous stem cell transplantation (post-ASCT) consolidation treatment were reported. Complete response (CR) is defined as negative immunofixation on the serum and urine, and disappearance of any soft tissue plasmacytomas, and less than (\<) 5 percent (%) PCs in bone marrow. sCR is defined as in addition to CR a normal FLC ratio, and absence of clonal plasma cells (PCs) by immunohistochemistry or immunofluorescence or 2 to 4-color flow cytometry.
Time frame: From randomization to post-ASCT consolidation (after Cycle 6) before maintenance treatment (up to 10 months)
Population: Response-evaluable analysis set included all participants who had a confirmed diagnosis of multiple myeloma and measurable disease at baseline or screening visit, received at least 1 dose of study treatment and had at least 1 post baseline disease assessment. The outcome measure was planned to be reported for randomized participants only.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Stringent Complete Response (sCR) | 32.0 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Stringent Complete Response (sCR) | 42.4 Percentage of participants |
Duration of Complete Response or Better
Duration of CR or better is the duration from the date of initial documentation of a CR or sCR response, according to the IMWG criteria, to the date of first documented evidence of progressive disease (PR), or relapse from CR. PD is defined as an increase of 25 % from the lowest response value in one of the following: serum and urine M-component (absolute increase must be greater than or equal to \[\>=\] 0.5 gram per deciliter \[g/dL\] and \>=200 milligrams \[mg\]/24 hours respectively); Only in participants without measurable serum and urine M-protein levels the difference between involved and uninvolved FLC levels (absolute increase must be \> 10 mg/dL); Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; Development of hypercalcemia (corrected serum calcium \>11.5 mg/dL) that can be attributed solely to plasma cells (PCs) proliferative disorder.
Time frame: From randomization to the date of first documented evidence of progressive disease or relapse from CR (up to 5 years)
Population: Population analyzed included response evaluable analysis set who achieved response (PR or better).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Duration of Complete Response or Better | NA Months |
| Randomized: Daratumumab+RVd (D-RVd) | Duration of Complete Response or Better | NA Months |
| Safety Run-in: D-RVd | Duration of Complete Response or Better | NA Months |
Duration of Response
Duration of response is defined as the duration from the date of initial documentation of a response (PR or better) according to the IMWG criteria to the date of first documented evidence of progressive disease according to the IMWG criteria. PD is defined as an increase of 25 % from the lowest response value in one of the following: serum and urine M-component (absolute increase must be \>= 0.5 g/dL and \>=200 mg/24 hours respectively); Only in participants without measurable serum and urine M-protein levels the difference between involved and uninvolved FLC levels (absolute increase must be \> 10 mg/dL); Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; Development of hypercalcemia (corrected serum calcium \>11.5 mg/dL) that can be attributed solely to PC proliferative disorder.
Time frame: From the date of initial documentation of a response (PR or better) to the date of first documented evidence of progressive (up to 5 years)
Population: Population analyzed included response evaluable analysis set who achieved response PR or better.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Duration of Response | NA Months |
| Randomized: Daratumumab+RVd (D-RVd) | Duration of Response | NA Months |
| Safety Run-in: D-RVd | Duration of Response | NA Months |
Duration of Stringent Complete Response (sCR)
Duration of sCR is the duration from the date of initial documentation of a sCR response, according to the IMWG criteria, to the date of first documented evidence of progressive disease, or relapse from sCR. PD is defined as an increase of 25 % from the lowest response value in one of the following: serum and urine M component (absolute increase must be \>= 0.5 g/dL and \>=200 mg/24 hours respectively); Only in participants without measurable serum and urine M-protein levels the difference between involved and uninvolved FLC levels (absolute increase must be \> 10 mg/dL); Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; Development of hypercalcemia (corrected serum calcium \>11.5 mg/dL) that can be attributed solely to PC proliferative disorder.
Time frame: From randomization to the date of first documented evidence of progressive disease or relapse from sCR (up to 5 years)
Population: Population analyzed included response evaluable analysis set who achieved response PR or better.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Duration of Stringent Complete Response (sCR) | NA Months |
| Randomized: Daratumumab+RVd (D-RVd) | Duration of Stringent Complete Response (sCR) | NA Months |
| Safety Run-in: D-RVd | Duration of Stringent Complete Response (sCR) | NA Months |
Overall Survival (OS)
OS is measured from the date of randomization to the date of the participant's death.
Time frame: From randomization to the date of initial documentation of participant's death (up to 5 years)
Population: ITT analysis set which included all randomized participants.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Overall Survival (OS) | NA Months |
| Randomized: Daratumumab+RVd (D-RVd) | Overall Survival (OS) | NA Months |
| Safety Run-in: D-RVd | Overall Survival (OS) | NA Months |
Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better
VGPR or better rate is defined as the percentage of participants who achieved VGPR or better, according to the IMWG criteria. VGPR is defined as serum and urine M-component detectable by immunofixation but not on electrophoresis, or \>= 90% reduction in serum M-protein plus urine M-protein \<100 mg/24 hours.
Time frame: From randomization to end of following: induction treatment, ASCT, post-ASCT consolidation (after Cycle 6) and at the end of maintenance period of 24 months (overall duration up to 34 months)
Population: Population analyzed included response evaluable analysis set who achieved response (PR or better). Here, 'n' (number analyzed) signifies number of participants analyzed at each specified timepoints.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the end of induction prior to ASCT | 56.7 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the end of ASCT prior to consolidation | 66.0 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the end of post-ASCT consolidation | 73.2 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the End of Maintenance Period (up to 24 Months) | 77.6 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the End of Maintenance Period (up to 24 Months) | 96.0 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the end of induction prior to ASCT | 71.7 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the end of post-ASCT consolidation | 90.9 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the end of ASCT prior to consolidation | 86.9 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the End of Maintenance Period (up to 24 Months) | 100.0 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the end of ASCT prior to consolidation | 100 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the end of post-ASCT consolidation | 100 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants Who Achieved Very Good Partial Response (VGPR) or Better | At the end of induction prior to ASCT | 68.8 Percentage of participants |
Percentage of Participants With Complete Response (CR) or Better
CR or better rate is defined as the percentage of participants who achieve CR or sCR, according to the IMWG criteria. CR is negative immunofixation on the serum and urine, and disappearance of any soft tissue plasmacytomas, and \< 5% PCs in bone marrow. sCR is defined as in addition to CR a normal FLC ratio, and absence of clonal plasma cells (PCs) by immunohistochemistry or immunofluorescence or 2 to 4-color flow cytometry. For 2 participants (1 in each randomized treatment group), data were updated by the study sites which resulted in their inclusion to the response-evaluable analysis set after the primary analysis.
Time frame: From randomization to end of following: induction treatment, ASCT, post-ASCT consolidation (after Cycle 6) and at the end of maintenance period of 24 months (overall duration up to 34 months)
Population: Response-evaluable analysis set included all participants who had a confirmed diagnosis of multiple myeloma and measurable disease at baseline or screening visit, received at least 1 dose of study treatment and had at least 1 post baseline disease assessment. Here, 'N' (number of participants analyzed) signifies number of participants evaluable for this outcome measure and 'n' (number analyzed) signifies number of participants analyzed at each specified timepoints.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Complete Response (CR) or Better | At the end of ASCT prior to consolidation | 19.6 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Complete Response (CR) or Better | At the end of induction prior to ASCT | 13.4 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Complete Response (CR) or Better | At the end of post-ASCT consolidation | 42.3 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Complete Response (CR) or Better | At the end of maintenance period (up to 24 Months) | 60.2 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Complete Response (CR) or Better | At the end of maintenance period (up to 24 Months) | 83.0 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Complete Response (CR) or Better | At the end of post-ASCT consolidation | 51.5 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Complete Response (CR) or Better | At the end of induction prior to ASCT | 19.2 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Complete Response (CR) or Better | At the end of ASCT prior to consolidation | 27.3 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Complete Response (CR) or Better | At the end of induction prior to ASCT | 12.5 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Complete Response (CR) or Better | At the end of ASCT prior to consolidation | 56.3 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Complete Response (CR) or Better | At the end of post-ASCT consolidation | 68.8 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Complete Response (CR) or Better | At the end of maintenance period (up to 24 Months) | 93.8 Percentage of participants |
Percentage of Participants With Negative Minimal Residual Disease (MRD)
Minimal residual disease negative rate is defined as the percentage of participants who achieve MRD negative status by the respective time point. Minimal residual disease was evaluated in participants who achieved CR or sCR (including participants with VGPR or better and suspected daratumumab interference) using next-generation sequencing which utilizes multiple myeloma cell DNA from bone marrow aspirates at a threshold of less than (\<) 10\^5.
Time frame: From randomization to end of following: induction treatment, post-ASCT consolidation (after Cycle 6) (up to 4.5 months), and at the end of maintenance period of 24 months (overall duration up to 34 months)
Population: Intent to treat (ITT) analysis set which included all randomized participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Negative Minimal Residual Disease (MRD) | At the End of Maintenance Period (up to 24 Months) (10^5) | 30.1 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Negative Minimal Residual Disease (MRD) | MRD from randomization to prior to ASCT (10^5) | 7.8 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Negative Minimal Residual Disease (MRD) | Post ASCT consolidation (10^5) | 20.4 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Negative Minimal Residual Disease (MRD) | At the End of Maintenance Period (up to 24 Months) (10^5) | 64.4 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Negative Minimal Residual Disease (MRD) | Post ASCT consolidation (10^5) | 50.0 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Negative Minimal Residual Disease (MRD) | MRD from randomization to prior to ASCT (10^5) | 22.1 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Negative Minimal Residual Disease (MRD) | At the End of Maintenance Period (up to 24 Months) (10^5) | 81.3 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Negative Minimal Residual Disease (MRD) | Post ASCT consolidation (10^5) | 50.0 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Negative Minimal Residual Disease (MRD) | MRD from randomization to prior to ASCT (10^5) | 18.8 Percentage of participants |
Percentage of Participants With Overall Response Rate (ORR)
ORR- percentage of participants who achieved partial response (PR) or better (PR, Very Good Partial Response \[VGPR\], CR or sCR) based on computerized algorithm as per IMWG criteria. PR -greater than or equal to (\>=) 50% reduction of serum M-protein and reduction in 24-hour urinary M-protein by \>=90% or to \<200 mg//24 hours. If serum and urine M-protein are not measurable, a decrease of \>=50% in the difference between involved and uninvolved FLC levels is required. A \>=50% reduction in the size of soft tissue plasmacytomas is also required; VGPR-serum and urine M-component detectable by immunofixation but not on electrophoresis, or \>= 90% reduction in serum M-protein plus urine M-protein \<100 mg/24 hours; CR-negative immunofixation on the serum and urine, and disappearance of any soft tissue plasmacytomas, and \<5% PCs in bone marrow. sCR- in addition to CR a normal FLC ratio, and absence of clonal PCs by immunohistochemistry or immunofluorescence or 2 to 4-color flow cytometry.
Time frame: From randomization to end of following: induction treatment, ASCT, post-ASCT consolidation (after Cycle 6) and at the end of maintenance treatment of 24 months (overall duration up to 34 months)
Population: Response-evaluable analysis set included all participants who had a confirmed diagnosis of multiple myeloma and measurable disease at baseline or screening visit, received at least 1 dose of study treatment and had at least 1 post baseline disease assessment. Here, 'n' (number analyzed) signifies number of participants analyzed at each specified timepoints.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Overall Response Rate (ORR) | At the end of induction prior to ASCT | 91.8 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Overall Response Rate (ORR) | At the end of ASCT prior to consolidation | 91.8 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Overall Response Rate (ORR) | At the end of post-ASCT consolidation | 91.8 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Overall Response Rate (ORR) | At the End of Maintenance Treatment (up to 24 Months) | 91.8 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Overall Response Rate (ORR) | At the End of Maintenance Treatment (up to 24 Months) | 99.0 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Overall Response Rate (ORR) | At the end of induction prior to ASCT | 98.0 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Overall Response Rate (ORR) | At the end of post-ASCT consolidation | 99.0 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Overall Response Rate (ORR) | At the end of ASCT prior to consolidation | 99.0 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Overall Response Rate (ORR) | At the End of Maintenance Treatment (up to 24 Months) | 100.0 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Overall Response Rate (ORR) | At the end of ASCT prior to consolidation | 100 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Overall Response Rate (ORR) | At the end of post-ASCT consolidation | 100 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Overall Response Rate (ORR) | At the end of induction prior to ASCT | 100 Percentage of participants |
Percentage of Participants With Overall Stringent Complete Response (sCR)
Overall sCR rate is defined as the percentage of participants who achieved sCR, according to the IMWG criteria. CR is defined as negative immunofixation on the serum and urine, and disappearance of any soft tissue plasmacytomas, and \< 5 % PCs in bone marrow. sCR is defined as in addition to CR a normal FLC ratio, and absence of clonal PCs by immunohistochemistry or immunofluorescence or 2 to 4-color flow cytometry.
Time frame: From randomization to end of following: induction treatment, ASCT, post-ASCT consolidation (after Cycle 6) and at the end of maintenance treatment of 24 months (overall duration up to 34 months)
Population: Response-evaluable analysis set included all participants who had a confirmed diagnosis of multiple myeloma and measurable disease at baseline or screening visit, received at least 1 dose of study treatment and had at least 1 post baseline disease assessment. Here, 'N' (number of participants analyzed) signifies number of participants evaluable for this outcome measure and 'n' (number analyzed) signifies number of participants analyzed at each specified timepoints.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of induction prior to ASCT | 7.2 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of ASCT prior to consolidation | 14.4 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of post-ASCT consolidation | 32.0 Percentage of participants |
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of Maintenance Treatment (up to 24 Months) | 48.0 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of Maintenance Treatment (up to 24 Months) | 67.0 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of induction prior to ASCT | 12.1 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of post-ASCT consolidation | 42.4 Percentage of participants |
| Randomized: Daratumumab+RVd (D-RVd) | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of ASCT prior to consolidation | 21.2 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of Maintenance Treatment (up to 24 Months) | 93.8 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of ASCT prior to consolidation | 43.8 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of post-ASCT consolidation | 56.3 Percentage of participants |
| Safety Run-in: D-RVd | Percentage of Participants With Overall Stringent Complete Response (sCR) | At the end of induction prior to ASCT | 0 Percentage of participants |
Progression-free Survival (PFS)
PFS is defined as the duration from the date of randomization to the date of first documented evidence of progressive disease or death, whichever comes first. PD is defined as an increase of 25 % from the lowest response value in one of the following: serum and urine M-component (absolute increase must be \>= 0.5 g/dL and \>=200 mg/24 hours respectively); Only in participants without measurable serum and urine M-protein levels the difference between involved and uninvolved FLC levels (absolute increase must be \> 10 mg/dL); Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; Development of hypercalcemia (corrected serum calcium \>11.5 mg/dL) that can be attributed solely to PC proliferative disorder.
Time frame: From randomization to the date of first documented evidence of progressive disease or death (up to 5 years)
Population: ITT analysis set which included all randomized participants.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Progression-free Survival (PFS) | NA Months |
| Randomized: Daratumumab+RVd (D-RVd) | Progression-free Survival (PFS) | NA Months |
| Safety Run-in: D-RVd | Progression-free Survival (PFS) | NA Months |
Time to Complete Response or Better
Time to CR or better is the duration from the date of randomization to the date of initial documentation of CR or better, which was confirmed by a repeated measurement as required by the IMWG criteria.
Time frame: From randomization to the date of initial documentation of CR (up to 5 years)
Population: Response-evaluable analysis set included all participants who had a confirmed diagnosis of multiple myeloma and measurable disease at baseline or screening visit, received at least 1 dose of study treatment and had at least 1 post baseline disease assessment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Time to Complete Response or Better | 9.6 Months |
| Randomized: Daratumumab+RVd (D-RVd) | Time to Complete Response or Better | 8.9 Months |
| Safety Run-in: D-RVd | Time to Complete Response or Better | 7.7 Months |
Time to Partial Response (PR) or Better
Time to PR or better is the duration from the date of randomization to the date of initial documentation of PR or better, which was confirmed by a repeated measurement as required by the IMWG criteria.
Time frame: From randomization to the date of initial documentation of PR or better (up to 5 years)
Population: Response-evaluable analysis set included all participants who had a confirmed diagnosis of multiple myeloma and measurable disease at baseline or screening visit, received at least 1 dose of study treatment and had at least 1 post baseline disease assessment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Time to Partial Response (PR) or Better | 0.8 Months |
| Randomized: Daratumumab+RVd (D-RVd) | Time to Partial Response (PR) or Better | 0.8 Months |
| Safety Run-in: D-RVd | Time to Partial Response (PR) or Better | 0.8 Months |
Time to Progression (TTP)
TTP is defined as the duration from the date of randomization to the date of first documented evidence of progressive disease according to the IMWG criteria.
Time frame: From randomization to the date of first documented evidence of progressive disease (up to 5 years)
Population: ITT analysis set which included all randomized participants.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Time to Progression (TTP) | NA Months |
| Randomized: Daratumumab+RVd (D-RVd) | Time to Progression (TTP) | NA Months |
| Safety Run-in: D-RVd | Time to Progression (TTP) | NA Months |
Time to Stringent Complete Response (sCR)
Time to sCR is the duration from the date of randomization to the date of initial documentation of sCR, which was confirmed by a repeated measurement as required by the IMWG criteria.
Time frame: From randomization to the date of initial documentation of sCR (up to 5 years)
Population: Response-evaluable analysis set included all participants who had a confirmed diagnosis of multiple myeloma and measurable disease at baseline or screening visit, received at least 1 dose of study treatment and had at least 1 post baseline disease assessment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Time to Stringent Complete Response (sCR) | 14.3 Months |
| Randomized: Daratumumab+RVd (D-RVd) | Time to Stringent Complete Response (sCR) | 10.2 Months |
| Safety Run-in: D-RVd | Time to Stringent Complete Response (sCR) | 8.4 Months |
Time to Very Good Partial Response (VGPR) or Better
Time to VGPR or better is the duration from the date of randomization to the date of initial documentation of VGPR or better, which was confirmed by a repeated measurement as required by the IMWG criteria.
Time frame: From randomization to the date of initial documentation of VGPR or better (up to 5 years)
Population: Response-evaluable analysis set included all participants who had a confirmed diagnosis of multiple myeloma and measurable disease at baseline or screening visit, received at least 1 dose of study treatment and had at least 1 post baseline disease assessment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Randomized: Lenalidomide+Bortezomib+Dexamethasone (RVd) | Time to Very Good Partial Response (VGPR) or Better | 3.0 Months |
| Randomized: Daratumumab+RVd (D-RVd) | Time to Very Good Partial Response (VGPR) or Better | 2.2 Months |
| Safety Run-in: D-RVd | Time to Very Good Partial Response (VGPR) or Better | 2.1 Months |