Recent results from the phase 3 AURIGA trial show that adding subcutaneous daratumumab to lenalidomide maintenance significantly boosts minimal residual disease (MRD) negativity rates in patients with newly diagnosed multiple myeloma (NDMM) after transplant, especially in MRD-positive cases.

The addition of daratumumab led to more durable disease control, with over twice the rate of sustained MRD negativity for at least six months and nearly four times for at least a year, indicating improved long-term outcomes.

Overall, these findings suggest that incorporating daratumumab into post-transplant maintenance therapy could become a new standard of care for MRD-positive myeloma patients, given its impact on MRD clearance and progression-free survival.

Patients receiving daratumumab showed a MRD-negative conversion rate of approximately 60.6% at a sensitivity of 10^-5, significantly higher than the 28.7% observed with lenalidomide alone, and these rates increased over time.

The improved MRD-negative conversion with daratumumab was consistent across various patient subgroups, regardless of age or race, and reached around 60.6% at 24 months.

Progression-free survival (PFS) was notably better with the daratumumab combination, with median PFS not reached versus 47.2 months for lenalidomide alone, and 3-year PFS rates of 76.8% compared to 61.4%, while early overall survival trends also favored daratumumab.

The study involved a 1:1 randomization of 200 patients aged 18 to 79, monitored over a median of 40.3 months, with stratification by high-risk cytogenetics, and primary endpoint focused on MRD-negative conversion at 12 months.

Safety analyses showed no new concerns, with similar rates of grade 3/4 adverse events such as neutropenia, infections, and hypertension in both groups, and manageable safety profiles overall.

Adverse events were comparable between groups, with infusion-related reactions mostly occurring during the first dose, emphasizing the importance of patient monitoring during initial treatment.

Patients on daratumumab tended to stay on treatment longer and had lower discontinuation rates, reflecting good tolerability and adherence.