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Belantamab mafodotin plus lenalidomide and dexamethasone shows high response in unfit multiple myelomaEarly trial shows promising results for a new drug combination in frail multiple myeloma patients

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Key Takeaway
Consider belantamab mafodotin regimen for unfit NDMM, but note early-phase data and ocular safety.

This Phase 1/2 randomized controlled trial evaluated belantamab mafodotin combined with lenalidomide and dexamethasone in unfit and frail transplant-ineligible patients with newly diagnosed multiple myeloma. The study included 42 patients at the recommended Phase 2 dose, with a median follow-up of 39.3 months. The primary outcome was not reported, but secondary outcomes included overall response rate, progression-free survival, and ocular toxicities.

Main results showed an overall response rate of 97.6%, 18-month progression-free survival of 83.0%, and time to progression of 97.2%. Median progression-free survival and overall survival were not reached yet. Safety data indicated ocular adverse events, with less than 1% of patients stopping driving or reading because of these events, and their impact on quality of life appeared limited.

Key limitations include the small sample size of 42 RP2D patients, lack of reported comparator, and early-phase design. The study suggests this regimen may be effective for this population, warranting a Phase 3 study, but clinical application should await further evidence due to these constraints.

Researchers conducted a Phase 1/2 trial to test a specific drug combination in patients who are unfit for standard transplants. The study included 36 patients in the first part and 30 randomized patients in the second part, all having newly diagnosed multiple myeloma. The main goal was to see if the drugs worked safely in this vulnerable group.

The results indicated that 97.6% of patients had an overall response to the treatment. Furthermore, 83% of patients were still progression-free at 18 months, and 97.2% had not progressed by the end of the follow-up period. Median survival times had not been reached yet during the study period.

Safety was a major focus, particularly regarding eye problems known as ocular adverse events. While these events occurred, less than 1% of patients stopped driving or reading because of them. The impact on quality of life appeared limited, suggesting the side effects were manageable for most people.

Readers should understand that this is early evidence from a small group of people. While the regimen looks effective, it is not yet a standard option. A larger Phase 3 study is needed to confirm these findings and determine if this treatment should be widely used.

What this means for you:
Early trial suggests this drug combo works well for frail myeloma patients, but larger studies are needed first.

Study Details

Study typeRct
Sample sizen = 36
EvidenceLevel 2
Follow-up1.8 mo
PublishedApr 2026
View Original Abstract ↓
The phase 1/2 BelaRd (belantamab mafodotin [belamaf], lenalidomide, and dexamethasone) study evaluated the efficacy and safety of belamaf combined with lenalidomide and dexamethasone in unfit and frail transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM). Part 1 (n = 36) established a recommended belamaf phase 2 dose (RP2D) of 1.9 mg/kg every 8 weeks (median follow-up, 39.3 months). In part 2, 30 patients were randomized 1:1 in group A (n = 15), where belamaf dosing was guided by ophthalmologist-assessed ocular adverse events (OAEs), whereas in group B (n = 15), belamaf dosing was based on hematologist-led vision-related anamnestic (VRA) tool and ophthalmologist-assessed grade ≥3 OAEs. Among the RP2D patients (n = 42), overall response rate was 97.6%, median progression-free survival (PFS)/overall survival have not been reached yet, and the 18-month PFS and time to progression rates were 83.0% and 97.2%, respectively. Ocular toxicities were similar between assessments by hematologists and ophthalmologists, and no ophthalmologist withholding of a hematologist-led dosing occurred. Less than 1% of patients stopped driving/reading because of OAEs. Median time to belamaf reinfusion was 13 weeks. Overall, BelaRd is an effective regimen for transplant-ineligible patients with NDMM and warrants a phase 3 study in this setting. OAEs' impact on quality of life appears limited, and implementation of the hematologist-led VRA tool may eventually reduce the necessity for ophthalmologist assessments. This trial was registered at www.clinicaltrials.gov as #NCT04808037.
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