Blenrep Regimen Shows Strong Responses in Newly Diagnosed Multiple Myeloma

Adding Blenrep (belantamab) to a standard treatment regimen produced high response rates and deep, lasting responses in patients with newly diagnosed multiple myeloma who were not eligible for a stem cell transplant, according to findings from the phase 1 DREAMM-9 trial presented at the 2026 ASCO Annual Meeting.

Researchers also identified a dosing schedule that appeared to balance effectiveness with safety, helping patients achieve deep responses while reducing the risk of eye-related side effects.

“Blenrep dosing in the induction phase with the higher dose intensity appears to be optimal in getting to the MRD [minimal residual disease] negativity rate,” said Dr. Saad Z. Usmani of Memorial Sloan Kettering Cancer Center during his presentation. “The longer dosing intervals during maintenance helps improve the tolerability and sustainability of response.”

What Is Blenrep?

Blenrep is a targeted therapy that works by attaching to a protein called BCMA, which is commonly found on multiple myeloma cells. Once attached, the drug delivers chemotherapy directly to the cancer cell and may also help the immune system recognize and attack the disease.

The drug is already approved by the FDA in combination with Velcade (bortezomib) and dexamethasone for some patients whose multiple myeloma has returned after prior treatment. Researchers are now studying whether it can improve outcomes earlier in the disease course.

Who Was Included in the DREAMM-9 Trial?

The DREAMM-9 study enrolled 118 patients with newly diagnosed multiple myeloma who were not eligible for an autologous stem cell transplant because of age, frailty or other health conditions. Patients had not received prior systemic treatment for their disease.

The median patient age was 74 years, and approximately 45% of patients were 75 years or older. Additionally, 16% had high-risk genetic features and 13% had disease outside the bone marrow, known as extramedullary disease.

All patients received a standard treatment combination of Velcade, Revlimid (lenalidomide) and dexamethasone during the first eight treatment cycles. Researchers then tested several Blenrep dosing schedules to determine which approach offered the best balance between effectiveness and side effects.

Higher-Dose Induction Therapy Led to Deeper Responses

Researchers found that giving Blenrep more frequently during the early phase of treatment helped patients achieve deeper responses.

Patients treated on the every-six-week induction and every-eight-week maintenance schedule experienced some of the strongest outcomes. In this group, 96% of patients responded to treatment, 88% achieved a complete response or better, and 54% became minimal residual disease (MRD)-negative. MRD negativity means highly sensitive testing could not detect remaining cancer cells.

Patients treated on the every-three-week induction and every-four-week maintenance schedule also had strong outcomes, with a 90% response rate and a 55% MRD negativity rate. Response rates were somewhat lower among patients treated with less frequent dosing schedules during induction.

Within the every-six-week induction group, researchers found that the higher 1.9 mg/kg dose produced deeper and faster responses than the 1.4 mg/kg dose. Patients receiving the higher dose achieved MRD negativity in a median of 7.9 months compared with 14.6 months for those receiving the lower dose.

“If you look at the q6/q8-week schedule, there is high overall response rate with a very comparable MRD negativity rate to even that initial higher dose intensity schedule,” Usmani said.

Longer Dosing Intervals Improved Tolerability

One of the biggest concerns with Blenrep treatment is the risk of eye-related side effects.

Investigators found that extending the time between doses during maintenance treatment reduced the number of severe eye-related side effects while maintaining strong treatment responses.

Across the study, 92% of grade 2 or higher eye-related side effects eventually resolved. Severe eye-related side effects were reported less often among patients receiving the longer dosing schedules than among those receiving more frequent dosing.

Importantly, only 3% of patients stopped Blenrep because of severe eye-related side effects, and all of those discontinuations occurred in the most frequent dosing group. No patients receiving the less frequent schedules stopped treatment because of these side effects.

Researchers also evaluated vision-related function, which includes activities such as reading and driving. Patients treated with extended dosing intervals generally maintained their vision-related quality of life throughout treatment.

Which Dosing Schedule Will Move Forward?

Based on the findings, investigators concluded that a higher dose of Blenrep early in treatment followed by less frequent dosing later may provide the best balance between effectiveness and safety.

“The longer dosing intervals during maintenance helps improve the tolerability and sustainability of response,” Usmani said.

The data support the use of Blenrep at 1.9 mg/kg every eight weeks for 24 weeks, followed by dosing every 12 weeks. This strategy is now being studied in the ongoing phase 3 DREAMM-10 trial and the PrE1005 study in patients with newly diagnosed, transplant-ineligible multiple myeloma.

What the Findings Mean for Patients

Patients who are not eligible for a stem cell transplant are often older and may have additional health conditions that make treatment more challenging.

The DREAMM-9 findings suggest that adding Blenrep to standard therapy can lead to deep responses while remaining manageable when given on an optimized schedule. Researchers believe the approach may help more patients achieve MRD negativity, a milestone that has been linked to improved long-term outcomes in multiple myeloma.

Usmani also noted that Blenrep may be particularly important because it could provide access to a BCMA-targeted treatment for patients who may not have access to newer cellular therapies.

“Only about one-fourth of the world’s myeloma population has access to T-cell redirecting therapies,” Usmani said. “So I think there is room to develop BCMA-directed treatments that are easily accessible for the majority of patients around the world, especially for the older patient population.”

References

1. DREAMM-9 Final Analysis: Belantamab Mafodotin (Belamaf), Bortezomib, Lenalidomide, and Dexamethasone (BVRd) for Transplant-Ineligible Newly Diagnosed Multiple Myeloma (NDMM). Saad Usmani , Mielnik M, Alonso A, et al. Presented at the 2026 American Society of Clinical Oncology Annual Meeting; May 29-June 2, 2026; Chicago, Illinois.
2. DREAMM-9 Final Analysis: Belantamab Mafodotin (Belamaf), Bortezomib, Lenalidomide, and Dexamethasone (BVRd) for Transplant-Ineligible Newly Diagnosed Multiple Myeloma (NDMM). Saad Usmani, Mielnik M, Alonso A, et al. Journal of Clinical Oncology. 2026

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