Dr Dimopoulos on BVd vs DVd in Relapsed/Refractory Multiple Myeloma With High-Risk Cytogenetic Features

“[The DREAMM-7 trial] showed that [BVd] was associated with a significant improvement in PFS and OS [compared with DVd].”

Meletios A. Dimopoulos, MD, professor and chairman of the Department of Clinical Therapeutics at the National and Kapodistrian University of Athens School of Medicine, discussed findings from a subgroup analysis of the phase 3 DREAMM-7 trial (NCT04246047) evaluating belantamab mafodotin (Blenrep) in combination with bortezomib (Velcade) and dexamethasone (BVd) compared with daratumumab (Darzalex), bortezomib, and dexamethasone (DVd) in patients with relapsed or refractory multiple myeloma, including those with high-risk cytogenetic features.

The DREAMM-7 trial enrolled patients with relapsed or refractory multiple myeloma who had received at least 1 prior line of therapy, including lenalidomide (Revlimid) in most cases, reflecting current treatment patterns. Belantamab mafodotin is an antibody-drug conjugate targeting BCMA, whereas daratumumab is an anti-CD38 monoclonal antibody. In DREAMM-7, both agents were combined with the standard bortezomib-plus-dexamethasone backbone. The subgroup analysis focused on patients with high-risk cytogenetics, such as those with 17p deletions or translocation 4;14 or 14;16 abnormalities, which are associated with inferior outcomes.

According to Dimopoulos, the addition of belantamab mafodotin to bortezomib and dexamethasone was associated with a significant improvement in both progression-free survival (PFS) and overall survival (OS) compared with the DVd regimen, including in the high-risk cytogenetic subgroup. These findings suggest that BVd may offer an important therapeutic option for patients progressing on lenalidomide, who represent a growing proportion of the relapsed/refractory multiple myeloma population, he said. Dimopoulos noted that belantamab mafodotin–based therapy, pending regulatory approval, may become one of the more attractive treatment options in this setting.

Importantly, the efficacy signal observed with BVd in the high-risk subgroup aligns with results seen in the overall trial population, underscoring the potential benefit across cytogenetic risk categories. Notably, as with other BCMA-directed therapies, ocular toxicity remains a consideration with belantamab mafodotin use.