Daratumumab + Lenalidomide + Dexamethasone (D-Rd, MAIA — MM 1L transplant-ineligible)

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

Knowledge-base record for audit. Provisional clinical content: this is not a prescription. An oncologist must verify original sources, applicability and review status. Full rules and constraints are in the YAML.

Source YAML: complete record

Components	`DRUG-DARATUMUMAB` `DRUG-LENALIDOMIDE` `DRUG-DEXAMETHASONE`

ID	`REG-D-RD-MAIA`
Type	Regimen
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-ESMO-MM-2023` `SRC-NCCN-MM-2025`

Notes

MAIA (Facon 2019, NEJM; updated 2021): D-Rd vs Rd in transplant- ineligible newly-diagnosed MM (median age 73). mPFS not reached vs 34.4 mo (HR 0.53); 5-y OS 66% vs 53%. Best-evidence 1L for transplant-ineligible MM. SC daratumumab (1800 mg + hyaluronidase) preferred from cycle 2 — substantially shorter chair time and lower IRR rate. HBV screening + entecavir prophylaxis for any HBV-positive serology. Pre-treatment red-cell phenotyping (daratumumab interferes with crossmatch — anti-CD38 binds CD38 on RBCs, causing positive indirect Coombs panreactivity). Continuous treatment until progression.

Used By

Indication

IND-MM-1L-DARA-RD - IND-MM-1L-DARA-RD
IND-MM-ELDERLY-FRAIL-VRD-LIGHT - IND-MM-ELDERLY-FRAIL-VRD-LIGHT