Multiple Myeloma Hub

Ciltacabtagene autoleucel (cilta-cel) is a B-cell maturation antigen (BCMA)-targeting chimeric antigen receptor (CAR) T-cell therapy, which is one of only two U.S. Food and Drug Administration (FDA)-approved CAR T-cell therapies for the treatment of relapsed/refractory multiple myeloma (RRMM). Both approved CAR T-cell agents are indicated in the heavily pre-treated setting after four or more prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.

However, in February 2024, the European Medicines Agency (EMA) Committee for Medicinal Products for Human Use (CHMP) recommended the approval of cilta-cel after at least one prior line of therapy, including an immunomodulatory agent or proteasome inhibitor, for those who have progressed on the last therapy and are refractory to lenalidomide.

The Multiple Myeloma Hub is pleased to summarize the rationale for and latest data from clinical trials of cilta-cel after one to three lines of therapy for the treatment of MM.

Read the article here: https://multiplemyelomahub.com/medical-information/integrating-cilta-cel-into-earlier-lines-of-therapy-rationale-and-latest-data-from-cartitude-2-and-cartitude-4

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During the 65th American Society of Hematology Annual Meeting and Exposition, Dima presented results from a retrospective analysis to evaluate the real-world safety and efficacy of teclistamab, with a focus on patients who would have been ineligible for the MajesTEC-1 trial. We summarize the key findings in this podcast.

To read this article on the Multiple Myeloma Hub, click here: https://multiplemyelomahub.com/medical-information/teclistamab-real-world-safety-and-efficacy

This educational resource is independently supported by Johnson & Johnson. All content is developed by SES in collaboration with an expert steering committee; funders are allowed no influence on the content of this resource.

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During the Multiple Myeloma Hub Steering Committee Meeting in May 2024, key opinion leaders met to discuss key considerations regarding infections associated with bispecific antibodies. Meral Beksaç​ opened with a presentation reviewing the infectious complications associated with bispecific antibodies, and current treatment algorithms for such infections. Beksaç​ explored an analysis of infections and parameters of humoral immunity in the MonumenTAL-1 study, the clinical management of infections, and regional differences in access to prophylaxis and treatment for infections. 

Following her presentation, Beksaç​ chaired a Q&A session featuring Hermann Einsele, Paul Richardson, Heinz Ludwig, María-Victoria Mateos, Elena Zamagni, and Vania Tietsche De Moraes Hungria. Discussions included COVID infections, the need for vaccination in donors of immunoglobulins for IVIG treatment, and the impact of dosing schedules on reducing infectious complications and T‑cell exhaustion. 

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During the Multiple Myeloma Hub Steering Committee Meeting in May 2024, key opinion leaders met to discuss the current use of CAR T-cell therapies in clinical practice, with a focus on patient-specific considerations in the development of personalized treatment plans. 

To open, Hermann Einsele provides a presentation reviewing the latest data from trials of ciltacabtagene autoleucel (cilta-cel) and idecabtagene vicleucel (ide-cel) in relapsed/refractory multiple myeloma (RRMM), including the KarMMa and CARTITUDE trials. He explores criteria for the identification of patients who may benefit from CAR T-cell therapy, mechanisms of resistance to BCMA CAR T-cell therapy, and the rationale for the earlier application of CAR T-cell therapies in MM. Einsele provides a review of the toxicities associated with immunotherapies, including strategies for prevention and monitoring, management techniques for CRS and ICANS, and infection prophylaxis and management. 

Following his presentation, Einsele chaired a Q&A session featuring Paul Richardson, Heinz Ludwig, María-Victoria Mateos, Meral Beksaç, Elena Zamagni, and Vania Tietsche De Moraes Hungria. 

Discussions included the implementation of CAR T-cell therapies in earlier lines of therapy, CAR T-cell therapies in high-risk disease, maintenance after CAR T-cell therapies, and toxicities with CAR T-cell therapies and bispecifics. 

This educational resource is independently supported by Bristol Myers Squibb. All content is developed by SES in collaboration with an expert steering committee; funders are allowed no influence on the content of this resource. 

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The Multiple Myeloma Hub was pleased to speak to Shaji Kumar, Mayo Clinic, Rochester, US, and Naresh Bumma, The Ohio State University, Columbus, US. We asked, How to select maintenance therapies post-autologous stem cell transplant (ASCT) for patients with high-risk MM?

In this expert discussion, Shaji Kumar and Naresh Bumma provide their insights into post-ASCT maintenance therapy for high-risk patients. The experts consider the use of lenalidomide as a monotherapy versus in combination with a proteosome inhibitor, whilst sharing their thoughts on the challenges in defining the high-risk population.

Kumar and Bumma present their individual management strategies for this patient population and examine existing clinical data, highlighting the need for prospective trials. This discussion concludes with a look to the future management of high-risk multiple myeloma post-ASCT.

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The Multiple Myeloma Hub was pleased to speak to Hira Mian, McMaster University, Hamilton, CA. We asked, Should risk-adapted MM treatment be informed by age or frailty status?

In this podcast, Hira Mian discusses the relationship between age and frailty status, sharing her perspective on how they may inform treatment strategies for patients with multiple myeloma. Mian examines the influence of age on frailty status, but notes other influential factors featured in the International Myeloma Working Group (IMWG) frailty score. Mian concludes with the importance of a comprehensive frailty assessment to inform a risk-adapted treatment plan.

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During the 64th American Society of Hematology (ASH) Annual Meeting and Exposition, the Multiple Myeloma Hub was pleased to speak to Timothy Schmidt, University of Wisconsin-Madison, Madison, US. We asked, How is the immune reconstitution in patients who stop therapy after achieving minimal residual disease (MRD) negativity?

In this interview, Schmidt discusses their poster presented at ASH 2022 entitled: Humoral immune reconstitution following therapy with daratumumab, carfilzomib, lenalidomide and dexamethasone (Dara-KRd), autologous hematopoietic cell transplantation (AHCT) and MRD-response-adapted treatment cessation. Schmidt discusses this post hoc analysis of the MASTER trial, examining the markers for humoral immune reconstitution amongst patients who were able to cease therapy, based on two successive MRD-negative assessments. Moving forward, Schmidt goes on to outline the results of humoral immune reconstitution based on whether patients ceased therapy following transplant or after transplant and Dara-KRd consolidation. Schmidt concludes by considering the potential of replicating this method of analysis in other studies.

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During the 64th American Society of Hematology (ASH) Annual Meeting and Exposition, the Multiple Myeloma Hub was pleased to speak to Vania Tietsche de Moraes Hungria, Clínica São Germano, São Paulo, BR. We asked, What are the main discrepancies between multiple myeloma (MM) treating centers in Brazil?

In this podcast, Hungria discusses their poster presented at ASH 2022 entitled: A Brazilian real-life experience of multiple myeloma patients: Final results from the Mmybrave multi-center study.

In particular, Hungria discusses the setting of this research, looking at the differences in the characteristics and overall survival of patients with MM in Brazil, considering the treatment center type, i.e., public or private institutions. Hungria considers the difference in access to drugs and the implications this may have on patients, and concludes by looking to the future for the improvement of treatment for all patients with MM in Brazil.

To find out more about this research study, read the Multiple Myeloma Hub summary here.

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During the 64th American Society of Hematology (ASH) Annual Meeting and Exposition, the Multiple Myeloma Hub was pleased to speak to Meral Beksac, Ankara University, Ankara, TR. We asked, What are the initial data of dara-CyBorD in patients with extramedullary disease?

In this podcast, Beksac discusses their poster presented at ASH 2022 entitled: Efficacy of daratumumab combined with bortezomib, cyclophosphamide and dexamethasone for the treatment of multiple myeloma patients presenting with extramedullary disease: a European Myeloma Network study. Beksac outlines the methods and motivations for this phase II open-label study, including the unmet need for patients with para-skeletal plasmacytomas, and concludes by discussing the study results in terms of progression-free survival, safety, and efficacy, and comparing these results with the previous LYRA study.

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