Daratumumab, lenalidomide, and dexamethasone versus daratumumab, bortezomib, and dexamethasone in relapsed and refractory multiple myeloma: A real-world propensity score-matched study

Cheng-Hsien Lin; Po-Wei Liao; Chieh-Lin Jerry Teng; Yu-Chen Su; Tsung-Chih Chen; Shun-Fa Yang; Bor-Sheng Ko

doi:10.1016/j.jfma.2026.03.120

Daratumumab, lenalidomide, and dexamethasone versus daratumumab, bortezomib, and dexamethasone in relapsed and refractory multiple myeloma: A real-world propensity score-matched study

J Formos Med Assoc. 2026 Apr 3:S0929-6646(26)00290-1. doi: 10.1016/j.jfma.2026.03.120. Online ahead of print.

Authors

Cheng-Hsien Lin¹, Po-Wei Liao², Chieh-Lin Jerry Teng³, Yu-Chen Su⁴, Tsung-Chih Chen⁵, Shun-Fa Yang⁶, Bor-Sheng Ko⁷

Affiliations

¹ Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
² Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan.
³ Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁴ Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan.
⁵ Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁶ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan. Electronic address: ysf@csmu.edu.tw.
⁷ School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: bskomd@ntu.edu.tw.

PMID: 41935929
DOI: 10.1016/j.jfma.2026.03.120

Abstract

Aims: Multiple myeloma (MM) is an incurable plasma cell malignancy. Daratumumab-lenalidomide-dexamethasone (DRd) and daratumumab-bortezomib-dexamethasone (DVd) are widely used in relapsed/refractory MM (RRMM) treatment. Although pivotal trials have established their efficacy, direct real-world comparisons are lacking. This study aimed to compare the effectiveness and safety of DRd and DVd in RRMM.

Methods: This is a multicenter retrospective cohort study using the TriNetX Global Collaborative Network. Patients with RRMM who initiated DRd (n = 849) or DVd (n = 1380) after January 1, 2017, were identified. Propensity score matching (1:1) of balanced baseline variables yielded 795 pairs. The primary endpoint was time to next treatment (TTNT), and the secondary endpoints were 5-year overall survival (OS) and adverse events. Survival was analyzed using the Kaplan-Meier method, log-rank test, and Cox regression.

Results: Median TTNT was longer with DRd than with DVd (32.6 vs. 17.7 months; hazard ratio [HR] 0.71; 95% confidence interval [CI], 0.62-0.81; p < 0.0001). Five-year OS was higher with DRd than with DVd (58.4% vs. 52.3%; HR 0.71; 95% CI, 0.59-0.86; p = 0.0003). Subgroup analyses consistently supported the DRd. Grade ≥3 neutropenia was more frequent with DRd than with DVd (27.7% vs. 12.5%), while grade ≥3 anemia was higher with the latter than with the former (12.9% vs. 7.6%). Other events occurred infrequently (<10%).

Conclusion: In this large real-world cohort, DRd yielded significantly longer TTNT, improved OS, and manageable toxicity than did DVd. DRd may be the preferred regimen for RRMM; randomized head-to-head trials are warranted.

Keywords: AEs; DRd; DVd; OS; RRMM; TTNT.