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Lenalidomide is an important component of initial therapy in newly diagnosed multiple myeloma, either as maintenance therapy post‐autologous stem cell transplantation (ASCT) or as first‐line therapy with dexamethasone for patients' ineligible for ASCT (non‐ASCT). This retrospective study investigated treatment patterns and outcomes for ASCT‐eligible and ‐ineligible patients who relapsed after lenalidomide as part of first‐line therapy, based on data from the Canadian Myeloma Research Group Database for patients treated between January 2007 and April 2019. Among 256 patients who progressed on lenalidomide maintenance therapy, 28.5% received further immunomodulatory derivative‐based (IMiD‐based) therapy (lenalidomide/pomalidomide) without a proteasome inhibitor (PI) (bortezomib/carfilzomib/ixazomib), 26.2% received PI‐based therapy without an IMiD, 19.5% received both an IMiD plus PI, 13.5% received daratumumab‐based regimens, and 12.1% underwent salvage ASCT. Median progression‐free survival (PFS) was longest for daratumumab‐based therapy (22.7 months) and salvage ASCT (23.4 months) and ranged from 6.6 to 7.3 months for the other treatments (P <.0001). Median overall survival (OS) was also longest for daratumumab and salvage ASCT. A total of 87 non‐ASCT patients received subsequent therapy, with 66.7% receiving bortezomib‐based therapy and 13.8% receiving other PI‐based therapy. Median PFS was 15.4 and 24.8 months for bortezomib‐based and other PI‐based therapy, respectively (P =.404). During most of the study period, daratumumab was not funded; in this setting, switching to a different therapeutic class following relapse on lenalidomide produced the longest remissions for non‐ASCT patients. Further prospective studies are warranted to determine optimum treatment following relapse on lenalidomide, especially in the light of increased access to daratumumab. [ABSTRACT FROM AUTHOR]

Daratumumab (dara) has significantly altered the therapeutic landscape of multiple myeloma (MM), especially in the relapsed setting. This study aimed to evaluate the outcomes of dara-containing regimens in the Canadian real-world setting among relapsed and refractory MM available within the national Canadian Myeloma Research Group Database (CMRG-DB). A total of 583 MM patients who received dara-based therapy in second-line or later treatment were included. After a median follow-up of 17.5 months, the median progression-free survival (PFS) and overall survival (OS) for the entire cohort were 13.1 and 32.9 months, respectively. The median PFS and OS were 23.5 and 49.1 months in second-line treatment and decreased to 12.8 and 43.0 months in third-line and 7.0 and 20.5 months in fourth-line treatment respectively. Dara in monotherapy with or without corticosteroids after a median of four prior lines of therapy resulted in a median PFS of 3.9 months and a median OS of 17.1 months. The addition of bortezomib, lenalidomide or pomalidomide to dara resulted in an improved median PFS and OS of 8.3 and 26.2 months; 26.8 and 43.0 months; and 9.7 and 31.4 months respectively. These retrospective data from the CMRG-DB suggest that outcomes are superior when dara is used in combination and in earlier lines of treatment., (© 2022 British Society for Haematology and John Wiley & Sons Ltd.)