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Belantamab mafodotin plus bortezomib and dexamethasone in patients with relapsed or refractory multiple myeloma DREAMM7 updated overall survival analysis from a global randomised open label phase 3 trial
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Daily Literature Update
Belantamab mafodotin plus bortezomib and dexamethasone in patients with relapsed or refractory multiple myeloma DREAMM7 updated overall survival analysis from a global randomised open label phase 3 trial
Hungria V, Robak P, Hus M, et al. Lancet Oncol. 2025;26(8):1067-1080. PMID: 40680754.
Introduction
Updated results from the DREAMM-7 trial reveal that belantamab mafodotin combined with bortezomib and dexamethasone improves overall survival in relapsed/refractory multiple myeloma compared to daratumumab-based therapy.
Study Overview
Study Type: Global, randomized, open-label phase 3 trial
Population: 494 patients with RRMM, median age 64.5 years
Intervention: BVd (belantamab mafodotin + bortezomib + dexamethasone) vs DVd (daratumumab + bortezomib + dexamethasone)
Outcomes: Progression-free survival (primary), overall survival, MRD negativity, duration of response, safety
- BVd significantly improved OS (HR 0.58, p=0.0002) with median OS not reached
- Double MRD negativity rates in BVd group (25% vs 10%)
- Longer median duration of response for BVd (40.8 vs 17.8 months)
- Higher thrombocytopenia rates with BVd (56% vs 35%) but manageable safety
Context & Related Research
- Hungria et al., 2024: Primary DREAMM-7 analysis showed PFS advantage with BVd (PMID: 38828933), reinforcing OS findings
- Hungria et al., 2025: Patient-reported outcomes demonstrated maintained quality of life with BVd (PMID: 40680752)
- Richter et al., 2025: Network meta-analysis favored belantamab-proteasome combos in RRMM (PMID: 40143674)
- Martino et al., 2025: Confirmed efficacy in lenalidomide-exposed cases (PMID: 40669094)
- Dimopoulos et al., 2024 (DREAMM-8): Belantamab-containing triplet superior to pomalidomide-based regimen (PMID: 38828951)
Clinical Implications
- Consider BVd as a new standard of care for RRMM after ≥1 prior therapy.
- Monitor and manage thrombocytopenia and ocular events proactively.
- BVd may be a convenient outpatient alternative with fewer severe toxicities than T-cell redirecting therapies.
Strengths & Limitations
| Strengths | Limitations |
|---|---|
| Large, phase 3 global randomized trial with mature OS data. | Open-label design; potential bias mitigated with blinded independent review. |
| Comprehensive endpoints including MRD and patient-reported outcomes. | Underrepresentation of Black patients; ongoing follow-up needed for long-term safety. |
Future Directions
Further investigation into long-term safety, optimal sequencing with other BCMA-targeted agents, and head-to-head trials of belantamab-based triplets are warranted.
Conclusion
Belantamab mafodotin plus bortezomib and dexamethasone significantly improves overall survival and response durability in RRMM, supporting its role as a new standard of care.
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