How do you modify Daratumumab-RVD relative to the protocols used in trials when used as a first-line agent to transplant-eligible patients with myeloma?

My modifications based off the GRIFFIN trial (Voorhees et al., PMID 32325490) are as follows:

If patients have high burden disease and no underlying neuropathy, I will start with twice-weekly bortezomib (days 1, 4, 8, 11) but will change the dexamethasone to 20 mg days 1, 4, 8, 11, and 15 using the traditional 21-day cycle with Len days 1-14 and Dara weekly. Often, after several cycles, I will drop to a once/week schedule of the bortezomib to reduce the risk of neuropathy. If issues with steroid-induced toxicity arise, then I will also dose-reduce the dexamethasone (e.g., to 20 mg/week).

For patients with underlying neuropathy or other co-morbidities that might be associated with increased toxicity from bortezomib, I tend to start with a wee...