Sustained minimal residual disease negativity in newly diagnosed multiple myeloma and the impact of daratumumab in MAIA and ALCYONE
In patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab reduced the risk of disease progression or death by 44% in MAIA (daratumumab/lenalidomide/dexamethasone [D-Rd]) and 58% in ALCYONE (daratumumab/bortezomib/melphalan/prednisone [D-VMP]). Minimal residual disea...
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Published in | Blood Vol. 139; no. 4; pp. 492 - 501 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Inc
27.01.2022
American Society of Hematology |
Subjects | |
Online Access | Get full text |
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Abstract | In patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab reduced the risk of disease progression or death by 44% in MAIA (daratumumab/lenalidomide/dexamethasone [D-Rd]) and 58% in ALCYONE (daratumumab/bortezomib/melphalan/prednisone [D-VMP]). Minimal residual disease (MRD) is a sensitive measure of disease and response to therapy. MRD-negativity status and durability were assessed in MAIA and ALCYONE. MRD assessments using next-generation sequencing (10−5) occurred for patients achieving complete response (CR) or better and after at least CR at 12, 18, 24, and 30 months from the first dose. Progression-free survival (PFS) by MRD status and sustained MRD negativity lasting ≥6 and ≥12 months were analyzed in the intent-to-treat population and among patients achieving at least CR. In MAIA (D-Rd, n = 368; lenalidomide and dexamethasone [Rd], n = 369) and ALCYONE (D-VMP, n = 350; bortezomib/melphalan/prednisone [VMP], n = 356), the median duration of follow-up was 36.4 and 40.1 months, respectively. MRD-negative status and sustained MRD negativity lasting ≥6 and ≥12 months were associated with improved PFS, regardless of treatment group. However, daratumumab-based therapy improved rates of MRD negativity lasting ≥6 months (D-Rd, 14.9% vs Rd, 4.3%; D-VMP, 15.7% vs VMP, 4.5%) and ≥12 months (D-Rd, 10.9% vs Rd, 2.4%; D-VMP, 14.0% vs VMP, 2.8%), both of which translated to improved PFS vs control groups. In a pooled analysis, patients who were MRD negative had improved PFS vs patients who were MRD positive. Patients with NDMM who achieved MRD-negative status or sustained MRD negativity had deep remission and improved clinical outcomes. These trials were registered at www.clinicaltrials.gov as #NCT02252172 (MAIA) and #NCT02195479 (ALCYONE).
•In patients with transplant-ineligible NDMM, durable MRD negativity is associated with improved PFS.•Daratumumab-based therapies are associated with higher rates and durability of MRD negativity.
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AbstractList | In patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab reduced the risk of disease progression or death by 44% in MAIA (daratumumab/lenalidomide/dexamethasone [D-Rd]) and 58% in ALCYONE (daratumumab/bortezomib/melphalan/prednisone [D-VMP]). Minimal residual disease (MRD) is a sensitive measure of disease and response to therapy. MRD-negativity status and durability were assessed in MAIA and ALCYONE. MRD assessments using next-generation sequencing (10-5) occurred for patients achieving complete response (CR) or better and after at least CR at 12, 18, 24, and 30 months from the first dose. Progression-free survival (PFS) by MRD status and sustained MRD negativity lasting ≥6 and ≥12 months were analyzed in the intent-to-treat population and among patients achieving at least CR. In MAIA (D-Rd, n = 368; lenalidomide and dexamethasone [Rd], n = 369) and ALCYONE (D-VMP, n = 350; bortezomib/melphalan/prednisone [VMP], n = 356), the median duration of follow-up was 36.4 and 40.1 months, respectively. MRD-negative status and sustained MRD negativity lasting ≥6 and ≥12 months were associated with improved PFS, regardless of treatment group. However, daratumumab-based therapy improved rates of MRD negativity lasting ≥6 months (D-Rd, 14.9% vs Rd, 4.3%; D-VMP, 15.7% vs VMP, 4.5%) and ≥12 months (D-Rd, 10.9% vs Rd, 2.4%; D-VMP, 14.0% vs VMP, 2.8%), both of which translated to improved PFS vs control groups. In a pooled analysis, patients who were MRD negative had improved PFS vs patients who were MRD positive. Patients with NDMM who achieved MRD-negative status or sustained MRD negativity had deep remission and improved clinical outcomes. These trials were registered at www.clinicaltrials.gov as #NCT02252172 (MAIA) and #NCT02195479 (ALCYONE). In patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab reduced the risk of disease progression or death by 44% in MAIA (daratumumab/lenalidomide/dexamethasone [D-Rd]) and 58% in ALCYONE (daratumumab/bortezomib/melphalan/prednisone [D-VMP]). Minimal residual disease (MRD) is a sensitive measure of disease and response to therapy. MRD-negativity status and durability were assessed in MAIA and ALCYONE. MRD assessments using next-generation sequencing (10−5) occurred for patients achieving complete response (CR) or better and after at least CR at 12, 18, 24, and 30 months from the first dose. Progression-free survival (PFS) by MRD status and sustained MRD negativity lasting ≥6 and ≥12 months were analyzed in the intent-to-treat population and among patients achieving at least CR. In MAIA (D-Rd, n = 368; lenalidomide and dexamethasone [Rd], n = 369) and ALCYONE (D-VMP, n = 350; bortezomib/melphalan/prednisone [VMP], n = 356), the median duration of follow-up was 36.4 and 40.1 months, respectively. MRD-negative status and sustained MRD negativity lasting ≥6 and ≥12 months were associated with improved PFS, regardless of treatment group. However, daratumumab-based therapy improved rates of MRD negativity lasting ≥6 months (D-Rd, 14.9% vs Rd, 4.3%; D-VMP, 15.7% vs VMP, 4.5%) and ≥12 months (D-Rd, 10.9% vs Rd, 2.4%; D-VMP, 14.0% vs VMP, 2.8%), both of which translated to improved PFS vs control groups. In a pooled analysis, patients who were MRD negative had improved PFS vs patients who were MRD positive. Patients with NDMM who achieved MRD-negative status or sustained MRD negativity had deep remission and improved clinical outcomes. These trials were registered at www.clinicaltrials.gov as #NCT02252172 (MAIA) and #NCT02195479 (ALCYONE). •In patients with transplant-ineligible NDMM, durable MRD negativity is associated with improved PFS.•Daratumumab-based therapies are associated with higher rates and durability of MRD negativity. [Display omitted] In patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab reduced the risk of disease progression or death by 44% in MAIA (daratumumab/lenalidomide/dexamethasone [D-Rd]) and 58% in ALCYONE (daratumumab/bortezomib/melphalan/prednisone [D-VMP]). Minimal residual disease (MRD) is a sensitive measure of disease and response to therapy. MRD-negativity status and durability were assessed in MAIA and ALCYONE. MRD assessments using next-generation sequencing (10-5) occurred for patients achieving complete response (CR) or better and after at least CR at 12, 18, 24, and 30 months from the first dose. Progression-free survival (PFS) by MRD status and sustained MRD negativity lasting ≥6 and ≥12 months were analyzed in the intent-to-treat population and among patients achieving at least CR. In MAIA (D-Rd, n = 368; lenalidomide and dexamethasone [Rd], n = 369) and ALCYONE (D-VMP, n = 350; bortezomib/melphalan/prednisone [VMP], n = 356), the median duration of follow-up was 36.4 and 40.1 months, respectively. MRD-negative status and sustained MRD negativity lasting ≥6 and ≥12 months were associated with improved PFS, regardless of treatment group. However, daratumumab-based therapy improved rates of MRD negativity lasting ≥6 months (D-Rd, 14.9% vs Rd, 4.3%; D-VMP, 15.7% vs VMP, 4.5%) and ≥12 months (D-Rd, 10.9% vs Rd, 2.4%; D-VMP, 14.0% vs VMP, 2.8%), both of which translated to improved PFS vs control groups. In a pooled analysis, patients who were MRD negative had improved PFS vs patients who were MRD positive. Patients with NDMM who achieved MRD-negative status or sustained MRD negativity had deep remission and improved clinical outcomes. These trials were registered at www.clinicaltrials.gov as #NCT02252172 (MAIA) and #NCT02195479 (ALCYONE).In patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab reduced the risk of disease progression or death by 44% in MAIA (daratumumab/lenalidomide/dexamethasone [D-Rd]) and 58% in ALCYONE (daratumumab/bortezomib/melphalan/prednisone [D-VMP]). Minimal residual disease (MRD) is a sensitive measure of disease and response to therapy. MRD-negativity status and durability were assessed in MAIA and ALCYONE. MRD assessments using next-generation sequencing (10-5) occurred for patients achieving complete response (CR) or better and after at least CR at 12, 18, 24, and 30 months from the first dose. Progression-free survival (PFS) by MRD status and sustained MRD negativity lasting ≥6 and ≥12 months were analyzed in the intent-to-treat population and among patients achieving at least CR. In MAIA (D-Rd, n = 368; lenalidomide and dexamethasone [Rd], n = 369) and ALCYONE (D-VMP, n = 350; bortezomib/melphalan/prednisone [VMP], n = 356), the median duration of follow-up was 36.4 and 40.1 months, respectively. MRD-negative status and sustained MRD negativity lasting ≥6 and ≥12 months were associated with improved PFS, regardless of treatment group. However, daratumumab-based therapy improved rates of MRD negativity lasting ≥6 months (D-Rd, 14.9% vs Rd, 4.3%; D-VMP, 15.7% vs VMP, 4.5%) and ≥12 months (D-Rd, 10.9% vs Rd, 2.4%; D-VMP, 14.0% vs VMP, 2.8%), both of which translated to improved PFS vs control groups. In a pooled analysis, patients who were MRD negative had improved PFS vs patients who were MRD positive. Patients with NDMM who achieved MRD-negative status or sustained MRD negativity had deep remission and improved clinical outcomes. These trials were registered at www.clinicaltrials.gov as #NCT02252172 (MAIA) and #NCT02195479 (ALCYONE). In patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab reduced the risk of disease progression or death by 44% in MAIA (daratumumab/lenalidomide/dexamethasone [D-Rd]) and 58% in ALCYONE (daratumumab/bortezomib/melphalan/prednisone [D-VMP]). Minimal residual disease (MRD) is a sensitive measure of disease and response to therapy. MRD-negativity status and durability were assessed in MAIA and ALCYONE. MRD assessments using next-generation sequencing (10−5) occurred for patients achieving complete response (CR) or better and after at least CR at 12, 18, 24, and 30 months from the first dose. Progression-free survival (PFS) by MRD status and sustained MRD negativity lasting ≥6 and ≥12 months were analyzed in the intent-to-treat population and among patients achieving at least CR. In MAIA (D-Rd, n = 368; lenalidomide and dexamethasone [Rd], n = 369) and ALCYONE (D-VMP, n = 350; bortezomib/melphalan/prednisone [VMP], n = 356), the median duration of follow-up was 36.4 and 40.1 months, respectively. MRD-negative status and sustained MRD negativity lasting ≥6 and ≥12 months were associated with improved PFS, regardless of treatment group. However, daratumumab-based therapy improved rates of MRD negativity lasting ≥6 months (D-Rd, 14.9% vs Rd, 4.3%; D-VMP, 15.7% vs VMP, 4.5%) and ≥12 months (D-Rd, 10.9% vs Rd, 2.4%; D-VMP, 14.0% vs VMP, 2.8%), both of which translated to improved PFS vs control groups. In a pooled analysis, patients who were MRD negative had improved PFS vs patients who were MRD positive. Patients with NDMM who achieved MRD-negative status or sustained MRD negativity had deep remission and improved clinical outcomes. These trials were registered at www.clinicaltrials.gov as #NCT02252172 (MAIA) and #NCT02195479 (ALCYONE). San Miguel et al evaluated the impact of dynamic, rather than single-point, assessment of measurable/minimal residual disease (MRD) by next-generation sequencing at a sensitivity of 10 −5 during remission on outcome in over 1400 patients in 2 randomized trials of first-line myeloma therapy. MRD negativity sustained over 12 months is associated with superior progression-free survival over either MRD positivity or nonsustained MRD negativity, regardless of frontline treatment regimen. In patients with transplant-ineligible NDMM, durable MRD negativity is associated with improved PFS. Daratumumab-based therapies are associated with higher rates and durability of MRD negativity. In patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab reduced the risk of disease progression or death by 44% in MAIA (daratumumab/lenalidomide/dexamethasone [D-Rd]) and 58% in ALCYONE (daratumumab/bortezomib/melphalan/prednisone [D-VMP]). Minimal residual disease (MRD) is a sensitive measure of disease and response to therapy. MRD-negativity status and durability were assessed in MAIA and ALCYONE. MRD assessments using next-generation sequencing (10 −5 ) occurred for patients achieving complete response (CR) or better and after at least CR at 12, 18, 24, and 30 months from the first dose. Progression-free survival (PFS) by MRD status and sustained MRD negativity lasting ≥ 6 and ≥12 months were analyzed in the intent-to-treat population and among patients achieving at least CR. In MAIA (D-Rd, n = 368; lenalidomide and dexamethasone [Rd], n = 369) and ALCYONE (D-VMP, n = 350; bortezomib/melphalan/prednisone [VMP], n = 356), the median duration of follow-up was 36.4 and 40.1 months, respectively. MRD-negative status and sustained MRD negativity lasting ≥6 and ≥12 months were associated with improved PFS, regardless of treatment group. However, daratumumab-based therapy improved rates of MRD negativity lasting ≥6 months (D-Rd, 14.9% vs Rd, 4.3%; D-VMP, 15.7% vs VMP, 4.5%) and ≥12 months (D-Rd, 10.9% vs Rd, 2.4%; D-VMP, 14.0% vs VMP, 2.8%), both of which translated to improved PFS vs control groups. In a pooled analysis, patients who were MRD negative had improved PFS vs patients who were MRD positive. Patients with NDMM who achieved MRD-negative status or sustained MRD negativity had deep remission and improved clinical outcomes. These trials were registered at www.clinicaltrials.gov as #NCT02252172 (MAIA) and #NCT02195479 (ALCYONE). |
Author | San-Miguel, Jesus Pei, Huiling Cavo, Michele Qi, Ming Wang, Jianping Krevvata, Maria Dimopoulos, Meletios A. Van Rampelbergh, Rian Paiva, Bruno Avet-Loiseau, Hervé Jakubowiak, Andrzej Mateos, María-Victoria Heuck, Christoph Kobos, Rachel Ramaswami, Priya Ukropec, Jon DeAngelis, Nikki Usmani, Saad Z. Touzeau, Cyrille Kudva, Anupa Sun, Steven Facon, Thierry Qi, Mia Kumar, Shaji Quach, Hang Cook, Gordon Bahlis, Nizar J. |
AuthorAffiliation | 13 Janssen Global Medical Affairs, Horsham, PA 18 Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada 5 University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France 6 University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain 15 Janssen Research & Development, LLC, Raritan, NJ 1 Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBER-ONC number CB16/12/00369, Pamplona, Spain 7 Hematology, University Hospital Hôtel-Dieu, Nantes, France 4 National and Kapodistrian University of Athens, Athens, Greece 3 Department of Hematology, Mayo Clinic, Rochester, MN 10 Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, United Kingdom 14 Janssen Research & Development, LLC, Titusville, NJ 12 University of Melbourne, St. Vincent’s Hospital, Melbourne, VIC 9 Levine Cancer Institute/Atrium Health, Charlo |
AuthorAffiliation_xml | – name: 14 Janssen Research & Development, LLC, Titusville, NJ – name: 17 Janssen Research & Development, Beerse, Belgium; and – name: 6 University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain – name: 12 University of Melbourne, St. Vincent’s Hospital, Melbourne, VIC – name: 4 National and Kapodistrian University of Athens, Athens, Greece – name: 9 Levine Cancer Institute/Atrium Health, Charlotte, NC – name: 8 University of Chicago Medical Center, Chicago, IL – name: 10 Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, United Kingdom – name: 13 Janssen Global Medical Affairs, Horsham, PA – name: 2 Unite de Genomique du Myelome, IUC-Oncopole, Toulouse, France – name: 16 Janssen Research & Development, LLC, Spring House, PA – name: 11 IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Università di Bologna, Bologna, Italy – name: 7 Hematology, University Hospital Hôtel-Dieu, Nantes, France – name: 15 Janssen Research & Development, LLC, Raritan, NJ – name: 1 Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBER-ONC number CB16/12/00369, Pamplona, Spain – name: 5 University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France – name: 3 Department of Hematology, Mayo Clinic, Rochester, MN – name: 18 Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada |
Author_xml | – sequence: 1 givenname: Jesus orcidid: 0000-0002-9183-4857 surname: San-Miguel fullname: San-Miguel, Jesus email: sanmiguel@unav.es organization: Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBER-ONC number CB16/12/00369, Pamplona, Spain – sequence: 2 givenname: Hervé surname: Avet-Loiseau fullname: Avet-Loiseau, Hervé organization: Unite de Genomique du Myelome, IUC-Oncopole, Toulouse, France – sequence: 3 givenname: Bruno orcidid: 0000-0003-1977-3815 surname: Paiva fullname: Paiva, Bruno organization: Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBER-ONC number CB16/12/00369, Pamplona, Spain – sequence: 4 givenname: Shaji orcidid: 0000-0001-5392-9284 surname: Kumar fullname: Kumar, Shaji organization: Department of Hematology, Mayo Clinic, Rochester, MN – sequence: 5 givenname: Meletios A. surname: Dimopoulos fullname: Dimopoulos, Meletios A. organization: National and Kapodistrian University of Athens, Athens, Greece – sequence: 6 givenname: Thierry surname: Facon fullname: Facon, Thierry organization: University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France – sequence: 7 givenname: María-Victoria orcidid: 0000-0003-2390-1218 surname: Mateos fullname: Mateos, María-Victoria organization: University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain – sequence: 8 givenname: Cyrille surname: Touzeau fullname: Touzeau, Cyrille organization: Hematology, University Hospital Hôtel-Dieu, Nantes, France – sequence: 9 givenname: Andrzej surname: Jakubowiak fullname: Jakubowiak, Andrzej organization: University of Chicago Medical Center, Chicago, IL – sequence: 10 givenname: Saad Z. surname: Usmani fullname: Usmani, Saad Z. organization: Levine Cancer Institute/Atrium Health, Charlotte, NC – sequence: 11 givenname: Gordon surname: Cook fullname: Cook, Gordon organization: Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, United Kingdom – sequence: 12 givenname: Michele surname: Cavo fullname: Cavo, Michele organization: IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Università di Bologna, Bologna, Italy – sequence: 13 givenname: Hang orcidid: 0000-0002-4796-3352 surname: Quach fullname: Quach, Hang organization: University of Melbourne, St. Vincent's Hospital, Melbourne, VIC – sequence: 14 givenname: Jon surname: Ukropec fullname: Ukropec, Jon organization: Janssen Global Medical Affairs, Horsham, PA – sequence: 15 givenname: Priya surname: Ramaswami fullname: Ramaswami, Priya organization: Janssen Research & Development, LLC, Titusville, NJ – sequence: 16 givenname: Huiling surname: Pei fullname: Pei, Huiling organization: Janssen Research & Development, LLC, Titusville, NJ – sequence: 17 givenname: Mia surname: Qi fullname: Qi, Mia organization: Janssen Research & Development, LLC, Raritan, NJ – sequence: 18 givenname: Steven surname: Sun fullname: Sun, Steven organization: Janssen Research & Development, LLC, Raritan, NJ – sequence: 19 givenname: Jianping surname: Wang fullname: Wang, Jianping organization: Janssen Research & Development, LLC, Raritan, NJ – sequence: 20 givenname: Maria surname: Krevvata fullname: Krevvata, Maria organization: Janssen Research & Development, LLC, Spring House, PA – sequence: 21 givenname: Nikki surname: DeAngelis fullname: DeAngelis, Nikki organization: Janssen Research & Development, LLC, Spring House, PA – sequence: 22 givenname: Christoph surname: Heuck fullname: Heuck, Christoph organization: Janssen Research & Development, LLC, Spring House, PA – sequence: 23 givenname: Rian surname: Van Rampelbergh fullname: Van Rampelbergh, Rian organization: Janssen Research & Development, Beerse, Belgium – sequence: 24 givenname: Anupa surname: Kudva fullname: Kudva, Anupa organization: Janssen Research & Development, LLC, Raritan, NJ – sequence: 25 givenname: Rachel surname: Kobos fullname: Kobos, Rachel organization: Janssen Research & Development, LLC, Raritan, NJ – sequence: 26 givenname: Ming surname: Qi fullname: Qi, Ming organization: Janssen Research & Development, LLC, Spring House, PA – sequence: 27 givenname: Nizar J. surname: Bahlis fullname: Bahlis, Nizar J. organization: Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34269818$$D View this record in MEDLINE/PubMed |
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Snippet | In patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab reduced the risk of disease progression or death by 44% in MAIA... San Miguel et al evaluated the impact of dynamic, rather than single-point, assessment of measurable/minimal residual disease (MRD) by next-generation... |
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SubjectTerms | Aged Antibodies, Monoclonal - therapeutic use Antineoplastic Combined Chemotherapy Protocols - therapeutic use Clinical Trials and Observations Female Humans Male Middle Aged Multiple Myeloma - diagnosis Multiple Myeloma - drug therapy Neoplasm, Residual - diagnosis Neoplasm, Residual - drug therapy Progression-Free Survival Treatment Outcome |
Title | Sustained minimal residual disease negativity in newly diagnosed multiple myeloma and the impact of daratumumab in MAIA and ALCYONE |
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