I appreciate that there are abstracts that are looking for data regarding lower / no dex. Dr. Mikhael paints a great picture of how dex could be used like a rocket booster on a spaceship. When the spaceship first takes off, it needs the power of rocket boosters to launch it but once it’s in space, the rocket boosters are no longer needed and fall off. So when a patient first starts a therapy, it’s always along with dex as it serves as a rocket booster to the therapy and makes it work better. The big question is . . . do we need to continue to use dex at the same dose, can it be lowered and maybe even no dex?

When I was diagnosed with myeloma in 2000, Quality of Life (QOL) was really not considered. There were so few treatment options, that it was all about finding a drug that worked and dealing with the side effects so you could stay alive. When I prepared for my Autologus Stem Cell Transplant (ASCT) in 2002, I pretreated with dex alone at a dose of 40 mg four days on / four days off for six months. It was difficult, but it worked. However, today that is unheard of and we have much better lower dose options to choose from (Thanks to clinical trials!)

In 2005 when I relapsed and selected a clinical trial with Revlimid and dex, it again was high dose dex. Once this combination was approved, I talked with my doctor about lowering the dose which we did over the years. I’m now enjoying remission with no dex! Which I’m grateful for, as well as my wife, LOL.

Mike Katz played an instrumental part in getting the Eastern Cooperative Oncology Group (ECOG) to do a trial on lowering dex. The results of which we are all enjoying today with 40 mg dex once a week as the Standard of Care (SOC), and many are now on much lower doses. Mike was a mentor, friend and patient advocate extraordinaire and paved the way for many of us to carry forward the importance of patient engagement.

With all of the above history, I was very interested in the IFM2017-03 trial (Oral #472) Health-Related Quality of Life for Frail Transplant-Ineligible Patients with Newly Diagnosed Multiple Myeloma Treated with Daratumumab, Lenalidomide and Dexamethasone: Subgroup Analysis of MAIA Trial

This is the first randomized trial dedicated to frail patients. I’ve included the study design, response and MRD rates and conclusion slides below for your reference. My takeaways are:

  • Dara-Rev was superior to Rev-dex for Overall Response Rate (ORR) of Very Good Partial Remission (VGPR) or better.
  • Safety profile was favorable without increased infection or pneumonia rates (really important for QOL!)
  • Sparing patients dex is encouraging!
  • The lower the dose the better in my opinion, as long as it keeps myeloma in remission

With that thought, my song selection for this blog is by Foreigner from 1991.
Here is “Low down & dirty”


Michael Tuohy