Multiple Myeloma Hub

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.

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.

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.

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.

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.

During the 19th International Myeloma Society Annual Meeting, the Multiple Myeloma Hub was pleased to speak to Roman Hájek, University of Ostrava, Ostrava, CZ. We asked, Which patients might benefit the most from isatuximab-based combinations in the relapsed setting?Hájek begins by explaining that isatuximab is an anti-CD38 monoclonal antibody currently approved for treatment in combination with pomalidomide + dexamethasone or carfilzomib + dexamethasone. This is followed by a discussion on why these combinations may be helpful for patients previously exposed or refractory to lenalidomide.

During a meeting of the Multiple Myeloma Hub Steering Committee on April 26, 2022, María‑Victoria Mateos chaired a recorded discussion that also featured Nina Shah, Paul Richardson, Morie Gertz, and Heinz Ludwig. The topic of this discussion was “Integrating B-cell maturation antigen (BCMA)-directed agents in the treatment landscape for relapsed/refractory multiple myeloma”, which was identified as an unmet need within multiple myeloma treatment.Mateos begins the discussion by posing the question of how to integrate chimeric antigen receptor (CAR) T-cell and other BCMA-directed products into clinical practice. Shah discusses the problems of CAR T-cell product availability, as well as the potential of bispecific therapies as they are more readily available. Richardson talks about antibody—drug conjugates (ADCs) and combination therapies, and the risk of keratopathy with some treatments. The committee discuss the convenience of ADCs and the potential of combinations using bispecific therapies and ADCs, with Gertz mentioning the exclusion of some patient subgroups from CAR T-cell trials, meaning bispecifics may be the best alternative for these individuals. Finally, Ludwig talks about the importance of more data becoming available to evaluate the use of BCMA-directed agents in earlier lines of therapy.

During a meeting of the Multiple Myeloma Hub Steering Committee on April 26, 2022, Morie Gertz chaired a recorded discussion that also featured María-Victoria Mateos, Nina Shah, Paul Richardson, and Elena Zamagni. The topic of this discussion was “The role of consolidation after autologous stem cell transplantation”, which was identified as an unmet educational need within multiple myeloma treatment.Gertz begins the discussion by explaining that patients often have confusion over what consolidation therapy is and when it can be used. Mateos then discusses how the number of induction therapy cycles a patient receives can affect the use of consolidation. Richardson talks about the STAMINA trial and how tolerability posttransplant can affect treatment choices, with Shah commenting on the difficulty of replicating trials in the real-world setting. The committee then discuss how historically in trials, the same drug that was used in induction is used as consolidation, and what the potential results would be if a different drug was used for consolidation.

During the ASCO 2022 Congress, the Multiple Myeloma Hub was pleased to speak to Roberto Mina, University of Turin, Turin, IT, and Andrzej J. Jakubowiak, The University of Chicago, Chicago, US. We asked, What are the pros and cons of bispecific antibodies for multiple myeloma? Mina and Jakubowiak discuss the MajesTEC-1 and MagnetisMM-1 trials, the efficacy and response rates of bispecific antibodies, and the challenges of using bispecific antibodies, such as infection risk. They also compare bispecific antibodies to CAR T-cell therapies and talk about the sequencing of therapies in myeloma treatment.