Dex for 2 cycles, then done. The Mayo group tested it prospectively, and efficacy held. Shebli flagged this Blood Cancer Journal paper from @myelomamd, Prashant Kapoor and team. Dara-IRd (dara, ixazomib, len, dex) for NDMM regardless of transplant eligibility, 78 pts in two sequential cohorts, with cohort B (n=40) getting dex for only 2 cycles. ORR 96%, ≥CR 32%, marrow MRD-neg 32%. At a median f/u of 37.9 mo, median PFS and OS are not reached. CR rates were similar in both cohorts, and stopping dex early did not impact efficacy. That dex finding is the part I care about most. In older pts, steroids drive so much of what makes induction hard: sleep, glucose, mood, muscle loss. Showing you can drop them early without losing response is useful well beyond this one regimen. 12 cycles of induction then 24 cycles of dara-ixazomib maintenance is roughly 3 years of therapy. Finite, yes, but not short. Grade 3+ AEs at least possibly drug related in 55%. The bigger caveat is translational. Sequential cohorts, not randomized, so the dex comparison is reassureing but not definitve. And 32% MRD-neg looks modest next to the D-VRd era numbers, with the usual caveats on timing and assays. I don't see this replacing D-VRd for fit pts. Where it could fit is the frail or community pt, where an oral PI means fewer chair visits. Is anyone already cutting dex after cycle 2 in older pts on D-VRd or D-Rd? #MultipleMyeloma #mmsm #NDMM