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COMy 2026 | Early intervention strategies in smoldering myeloma and high-risk MGUS
Irene Ghobrial, MD, Dana-Farber Cancer Institute, Boston, MA, discusses the potential benefits of early intervention with daratumumab in patients with smoldering myeloma, including those with low-risk and intermediate-risk disease, as well as high-risk monoclonal gammopathy of undetermined significance (MGUS). Dr Ghobrial reviews findings suggesting that patients outside traditional high-risk categories can still benefit from early treatment and outlines ongoing studies exploring whether intervention at earlier disease stages may prevent progression altogether. This interview took place at the 12th World Congress on Controversies in Multiple Myeloma (COMy) in Paris, France.
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Transcript
Yeah, so daratumumab has been now FDA-approved for high-risk smoldering myeloma based on the AQUILA data. But if you look at AQUILA, there were some patients who actually do not meet the high-risk criteria based on 20/2/20, but they still benefit, which tells you that also intermediate and low-risk smoldering myeloma patients may also benefit from early intervention, especially with something as simple as daratumumab...
Yeah, so daratumumab has been now FDA-approved for high-risk smoldering myeloma based on the AQUILA data. But if you look at AQUILA, there were some patients who actually do not meet the high-risk criteria based on 20/2/20, but they still benefit, which tells you that also intermediate and low-risk smoldering myeloma patients may also benefit from early intervention, especially with something as simple as daratumumab. What we tried to do was daratumumab in the lower-risk population, so that would be the low-risk smoldering and high-risk MGUS, to the population that did not meet the high-risk criteria for other trials. And we tried to say, well, if single-agent daratumumab can delay progression in our patients. And indeed, that study showed that we have about the same response rate that we see with daratumumab in high-risk smoldering myeloma. So also patients who are at lower risk can benefit from that simple intervention to prevent progression. And we’re doing now more studies in that early population with linvoseltamab, for three months or six months to see if we can eradicate the cells at an early time point and potentially prevent progression completely for many people.
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