Multiple Myeloma Hub

During the 18th International Myeloma Workshop, the Multiple Myeloma Hub spoke with Eli Muchtar, Mayo Clinic, Rochester, US and Suzanne Lentzsch, Columbia University, New York, US. We asked, The challenges of monitoring organ response in AL amyloidosis: What has been achieved so far?

The podcast focuses on both hematologic and organ response in amyloidosis, as well discussing the findings of a recent study.

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During the 7th World Congress on Controversies in Multiple Myeloma (COMy), the Multiple Myeloma Hub hosted its first Satellite Symposium: Should 'cure' be the goal for multiple myeloma? María-Victoria Mateos, University Hospital of Salamanca, Salamanca, ES, answered: Is the treatment of high-risk smoldering multiple myeloma (SMM) the way for achieving the cure?

In this podcast, Mateos discusses the progression of monoclonal gammopathy of undetermined significance (MGUS) and SMM to MM from a molecular point of view. She explains the 2/20/20 risk stratification model for SMM, and the phase III clinical trials that have demonstrated a benefit in treating patients with high-risk SMM to delay the progression to overt MM. In her road map to cure MM, early treatment of SMM is a crucial step, and she presents two curative approaches being currently investigated in clinical trials.

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During the 7th World Congress on Controversies in Multiple Myeloma (COMy), the Multiple Myeloma Hub hosted its first Satellite Symposium: Should 'cure' be the goal for multiple myeloma? Mohamad Mohty, Hôpital Saint-Antoine and Sorbonne University, Paris, FR, answered: Does 'cure' have a different meaning in MM?

In this podcast, Mohty discusses how the word 'cure' has different implications for young and older patients, and discusses the functional/operational cure for patients with standard- and high-risk disease. Mohty focuses on the importance of sustained MRD negativity on survival and why it should also be monitored by PET-CT. Seeing novel agent combinations reaching unprecedented results, he is hopeful that the cure rates will rise in both young and older patients with MM in the near future.

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During the 2021 ASCO Annual Meeting, the Multiple Myeloma Hub spoke with Clifton C. Mo and Omar Nadeem, Dana-Farber Cancer Institute, Boston, US. We asked, How to treat first relapse in lenalidomide-refractory multiple myeloma (MM)?

In this podcast, Mo and Nadeem discuss factors to be considered with regimen options for patients with lenalidomide-refractory MM. They discuss cardiac risk factors, lines of therapy, prognosis, and end the podcast on the topic of new agents.

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During the EHA2021 Virtual Congress, the Multiple Myeloma Hub spoke with Pieter Sonneveld, Erasmus MC, Rotterdam, NL. We asked, With the unprecedented results seen with novel therapies, what is needed to overcome the poor prognosis of high-risk multiple myeloma (MM)?

In this podcast, Sonneveld discusses trial results presented during EHA2021 on the efficacy of novel treatments for patients with high-risk MM, a patient group associated with poor outcomes and shorter remission rates. He believes that identifying high-risk patients and selecting them for more intensive targeted maintenance treatment could be crucial in preventing relapse.

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During the European School of Haematology (ESH) 3rd How to Diagnose and Treat Multiple Myeloma conference, the Multiple Myeloma Hub spoke to Xavier Leleu, Poitiers University Hospital, Poitiers, FR. We asked, When BCMA-directed therapy is not an option, how should we treat late relapse?

Leleu discusses three alternatives to anti-B-cell maturation antigen (BCMA) directed therapies, including alternative drugs (provided the patient is nonrefractory), enrolment to clinical trials investigating new treatments, and the use of developing agents administered in the context of compassionate use.

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During the 3rd European CAR T-cell Meeting, the Multiple Myeloma Hub spoke to Professor Philip McCarthy, Roswell Park Comprehensive Cancer Center, Buffalo, US. We asked, What do you need to remember when facing CAR T-cell toxicities?

In this podcast, McCarthy discusses the two main chimeric antigen receptor (CAR) T-cell toxicities: cytokine release syndrome (CRS), and immune effector cell-associated neurotoxicity syndrome (ICANS). Initially, McCarthy lists what to look out for in terms of symptoms in this highly practical podcast episode. He then describes the timeline for the appearance of these adverse advents and the current treatment strategies that are being used.

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During the National Comprehensive Cancer Network (NCCN) 2021 Annual Conference, the Multiple Myeloma Hub spoke to Natalie S. Callander, University of Wisconsin-Madison, Madison, US and Shaji K. Kumar, Mayo Clinic, Rochester, US. We asked, What are the key additions to the new NCCN guidelines for multiple myeloma?

Callander and Kumar discuss the inclusion of new diagnostic tools, such as MRD testing, risk-stratification for MM and it’s precursor stages, and changes to treatment regimens for newly diagnosed and relapsed MM. Callander also describes an important update for the recommendation of the combination of daratumumab, cyclophosphamide, bortezomib, and dexamethasone for the treatment of amyloidosis, providing supporting data from the phase III ANDROMEDA trial. They finish by discussing risk stratification and treatment intervention updates for smoldering MM.

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During the 2nd European Myeloma Network Meeting, the Multiple Myeloma Hub spoke to Professor Graham Jackson, Newcastle University, Newcastle upon Tyne, UK, and Professor Philippe Moreau, CHU de Nantes, Nantes, FR. We asked, If maintenance after induction reduces therapy options at relapse, is it still worth it?

Currently, the only approved maintenance therapy for multiple myeloma is lenalidomide. When answering whether this treatment is worth it, Jackson provides meta-analysis results of the CALGB 100104, IFM 2009, and Myeloma XI studies demonstrating improved progression-free survival by around 20−30 months compared with placebo.

Jackson and Moreau then discuss alternative treatments in patients who are refractory to lenalidomide, focusing on optimizing carfilzomib + dexamethasone, daratumumab, bortezomib + dexamethasone, and pomalidomide + dexamethasone-based regimens.

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During the 62nd American Society of Hematology (ASH) Annual Meeting and Exposition, the Multiple Myeloma Hub spoke to Elisabet E. Manasanch, MD Anderson Cancer Center, Houston, US, and Taxiarchis Kourelis, Mayo Clinic, Rochester, US. They discuss new findings regarding the role of the immune microenvironment presented at ASH 2020

In this podcast, Manasanch and Kourelis describe two studies on immune microenvironment changes in myeloma. The first study is a preliminary analysis of peripheral blood and bone marrow samples from patients with smoldering myeloma. This included identifying changes to immune cell composition and using RNA/DNA sequencing to identify biomarkers associated with immune changes in patients with disease progression. From the data, they outline possible new avenues in immune cell profiling for the prognosis of high-risk precursor patients, as well as therapeutic targeting, including the potential for curing at the precursor stage.

The second study for discussion compared major components of tumor ecosystems in patients with newly diagnosed/relapsed myeloma that are triple-class refractory. Kourelis brings attention to unhealthy T-cell compartments in more heavily pretreated patients compared with patients with newly diagnosed/relapsed disease and the implications for their response to T-cell-based immunotherapies.

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