housekeeping, doing laundry, using transportation, handling medication and handling finances. 9% of
the patients had at least grade 3, signifying problems with feeding, continence, toileting, dressing and
bathing (Fokkema EMN2021). This means that over one third of the patients had problems you do not
want patients to experience. Based on this, most experts in the field still would choose VRd over D-VTd
even if both were available.
Conclusion: Transplant-eligible patients should still get VRd induction.
Summary
Should all patients receive daratumumab in first line? Definitely no! Not frail patients, not high-risk
patients, and not transplant-eligible patients (before D-VRd becomes available). But if any patient
should get dara in first line, who should it be? I can see one clear situation. A transplant-ineligible, fit,
standard-risk patient; but only if money’s no issue, and you expect 2nd line treatment to improve before
the patient progresses. Otherwise VRd and then CD38ab-Kd at relapse, should still be the preferred
option.
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