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Daratumumab + Lenalidomide maintenance post-ASCT (PERSEUS schedule)

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Notes

PERSEUS maintenance arm (Sonneveld NEJM 2024, PMID 38084760): after D-VRd × 4 induction + ASCT + D-VRd × 2 consolidation, patients received daratumumab SC q4w (first 6 cycles then q8w) + lenalidomide 10 mg d1-21 until progression. Median maintenance duration ~38 months. Distinct from: (1) REG-LENALIDOMIDE-MAINTENANCE (len-only, no daratumumab — CALGB 100104 / IFM 2005-02 schema); (2) MRD-guided approaches (investigational). Key PERSEUS maintenance outcomes: 48-month PFS 84.3% (D-VRd arm) vs 67.7% (VRd arm); MRD-negativity (10⁻⁵) at 12 months post-consolidation 75.2% vs 47.5%. The PFS benefit was consistent across transplant-eligible subgroups including high-risk cytogenetics (del17p, t[4;14], t[14;16]). Daratumumab dosing transition in PERSEUS: q4w during consolidation and first 6 maintenance cycles → q8w thereafter. Some Ukrainian centers may default to q4w throughout for simplicity; both schedules are documented. Second primary malignancy (SPM) risk: the combination of ASCT + extended lenalidomide increases SPM risk (MDS/AML ~2-3% at 5 yr, solid tumors). Must be included in pre-consent discussion. Risk-benefit favors maintenance in standard-risk and high-risk NDMM given the magn...

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Indication

• IND-MM-1L-DVRD - IND-MM-1L-DVRD