Hematology

Myeloma   

Questions discussed in this category


What does it add beyond a serum electrophoresis or light chain testing? Are there certain types of patients where monitoring immunoglobulins is parti...

For example, how do you address tendency to "over-order" these tests in patients with common aches/pains but no structural abnormalities on advanced i...

Would you transplant a patient over the age of 70 with newly diagnosed myeloma? Does the risk category impact your decision?

E.g., for a patient with myeloma, s/p induction therapy, and high-dose chemotherapy, followed by autologous rescue with inappropriate antibody respons...

Is the therapeutic purpose of the proteasome inhibitor to maximize total dosage per week or number of infusions per week?

If there are light chain deposits on the kidney, is that conclusive of MGRS?

Triplet v. Quadruplet? Do you opt for VRd, DaraRD, CyBorD, Dara-RVd or another regimen?  How would this change for a patient with high risk cyt...

How frequently and what type of testing/sample are you performing MRD assessment? Does your approach differ between transplant-eligible and transplan...

Several patients with inability to access oral cyclophosphamide or lenalidomide, have attempted assistance and grants to no avail.

Given recent retrospective study showing potential lack of benefit with bortezomib-based maintenance therapy (Bumma et al., PMID 37021929).High-risk a...

Which PI and at what dosing intervals? Dexamethasone or not? Emory has now published data with VRd consolidation as well as KPd consolidation, while ...

Assuming there is clear laboratory and/or imaging evidence of disease progression, and assuming FISH data is already available from a prior biopsy, do...

Patient with stable disease on maintenance therapy with lenalidomide and dexamethasone

E.g. in a patient with tenuous cardiac function, would starting treatment several weeks earlier potentially improve outcomes?

Do you have a certain immunoglobulin level which you would use to determine this?

E.g. a patient with monoclonal protein with mild light chain ratio elevation. Do we need to get a BM biopsy in all such patients?

Other than in the setting of disease progression or significant treatment-related adverse event?

Infection is not part of the criteria for starting treatment both in UpToDate and in NCCN guidelines. 

Given the rarity of this diagnosis (5-7% of all AL amyloidosis cases), and the prognostic and clinical differences when compared to non IgM-AL am...

We know the longer we expose patients to lenalidomide, the harder collection will be. Would you collect now or switch to an alternative regimen to ach...

Are the early results of CASSIOPEIA (Abst 8003) from ASCO 2019 practice changing? What about the GRIFFIN results in 2020?

Do you modify the aspirin dose based off the lenalidomide dose? Do you ever use higher dose aspirin in lieu of an anticoagulant? The NCCN guidelines s...

CAR-T (any specific preference of product?) vs bispecific antibodies vs any other specific agents not previously utilized?

After 3-4 cycles of RVD, would you automatically take the patient to transplant if he has achieved at least a partial response, or is there any benefi...

Can you expand on this by sharing exactly what this routine workup should include? What additional tests outside of evaluating for POEMS and amyloidos...

If yes would you delay initiation of antineoplastic therapy to allow time for the vaccine to start acting?

How is this impacted by patient features, cytogenetics/disease biology, depth of response, or other factors? What would compel you to continue 3 drugs...

How do you factor in patient age, frailty, patients with underlying organ dysfunction, or other clinical features? Do you still consider CyBorD or R...

In your experience, do certain regimens have more cumulative toxicity, financial impact, or patient convenience factors?

Are there scenarios where you would use a higher dose of lenalidomide in a novel doublet or triplet (eg. relapse on lenalidomide maintenance)?

For example, in cold agglutinin disease or AIHA, antibodies can be detected via DAT, but are often not observed on assays for monoclonal gammopathies.

Is there any data justifying the use of systemic therapy over localized therapy (e.g. radiation or surgery) in this situation prior to a progression e...

For example, for joing replacement surgery? Do you hold the revlimid for certain about of time before and after?

Would your approach change based on the type of reaction (eg. Stevens-Johnson syndrome vs DRESS)? How would you address maintenance (if any) post-tra...

To me, the recent NEJM study is flawed in that the control arm did not have maintenance treatment while the experimental arm used maintenance Dar...

Would you proceed to autologous transplant, or switch to an alternate regimen (eg. daratumumab-based) first? Would the type or degree of organ involv...

Once a tissue biopsy has confirmed light chain amyloid, what additional tests do you perform as part of a standard workup? In whom should treatment b...

Do these events mandate discontinuation of lenalidomide therapy or switching to a different agent? Can appropriate therapy for these skin cancers be r...

Given the PFS benefit seen in the most recent ECOG-ACRIN, and the prior study of Rd showing an OS benefit, is your practice to put any high-risk SMM p...

For example - Would you offer tandem transplantation in a young, fit patient in a CR after first transplant, but with MRD detectable?

Although the MMR vaccine is contraindicated in immunosuppressed patients on anticancer treatment according to CDC/ACIP and IDSA guidelines, data on sa...

Given the recent results presented from the Griffin trial, would you choose a daratumumab-based regimen (eg. D-VRd) over other salvage options (V...

Has the recent data presented at ASH affected your choice of regimen? Would your choice differ between transplant-eligible and transplant-ineligible ...

Would MRD assessments affect your clinical decision making for MM patients outside of a clinical trial?

Specifically, what regimen would you choose in a patient with new renal failure but not requiring dialysis?

Does the choice of initial induction regimen affect your decision for when to employ lenalidomide maintenance? Are there situations where you would c...

Once you decide to begin treatment, any special precautions you would use for protein levels starting that high.

Subq has been shown to have lower risk of neuropathy. Is there any reason to use weekly IV still?

In a patient with multiple poor risk features including TP53 mutation, 1q amplification, stage III, and circulating plasma cells, would you consider a...

For example, how significant does the M protein have to increase for you to begin a conversation about new therapy?

Specifically, to you lean towards elotuzumab or a daratumumab-based regimen?

At what point is the neuropathy a contraindication to further bortezomib therapy?


Papers discussed in this category


JAMA, 2013-04-03

Haematologica, 2016-12-01

Clin Pharmacokinet, 2012-12-01

Blood, 2016-12-22

The New England journal of medicine, 2015-08-13

The Lancet. Oncology, 2010-01

The New England journal of medicine, 2014-09-04

The New England journal of medicine, 2019-05-30

Lancet (London, England), 2017-02-04

The New England journal of medicine, 2018-02-08

Blood, 2018-01-18

N Engl J Med,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1993-05

British journal of haematology, 2018-10

Blood Adv,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-10-10

The New England journal of medicine, 2017-04-06

Haematologica, 2011 Nov 04

Clin. Cancer Res., 2011 Feb 16

J. Clin. Oncol., 2013 Oct 21

Bone marrow transplantation, 2018-07

Blood, 2016 Mar 21

Lancet Oncol, 2020 Aug 28

N. Engl. J. Med.,

Leukemia, 2014-03

The Lancet. Oncology, 2014-03

The New England journal of medicine, 2012-05-10

Leukemia, 2019-01

Ann. Allergy Asthma Immunol., 2019 Aug 07

Clin Lymphoma Myeloma Leuk,

J Hematol Oncol, 2018 Jan 16

Blood, 2017-07-06

The Lancet. Oncology, 2019-06

Leuk Lymphoma, 2011 Dec 13

Haematologica, 2019 Oct 03

Lancet Oncol, 2019 Dec 16

N Engl J Med,

Lancet,

Cancer,

Blood, 2013-10-24

The Lancet. Oncology, 2011-08

The Lancet. Oncology, 2018-03

British journal of haematology, 2018-07

J Geriatr Oncol, 2021 Mar 06

Leukemia, 2018 Apr 25

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 Sep 27

Blood Cancer J, 2021 May 12

Leuk Lymphoma, 2019 Nov 18

Blood, 2013-10-03

Leukemia, 2019-09

Blood,

J Clin Oncol, 2012 Jul 16

Lancet (London, England), 2016-04-09

The Lancet. Oncology, 2019-06

Lancet Oncol,

Nature communications, 2019-04-23

Blood, 2012 Aug 13

J Clin Oncol, 2020 Apr 16

Blood,

The Lancet. Oncology, 2019-01

Blood,

J. Clin. Oncol., 2019 Oct 25

N Engl J Med,

The Lancet. Oncology, 2018-07

Blood Cancer J, 2020 Mar 09

JAMA Oncol,

Lancet, 2019 Jun 03

The Lancet. Oncology, 2021 Oct 13

The Lancet. Haematology, 2023 Sep 11

JCO Oncol Pract, 2020 Aug 21

Mayo Clin Proc,

Neurol Sci, 2021 Sep 16

American journal of kidney diseases : the official journal of the National Kidney Foundation, 2017-05

Transplant Proc,

Blood Cancer J, 2021 Jan 11

Blood cancer journal, 2018-06-12

JAMA Oncol,

Blood Cancer J, 2020 May 11

Lancet Oncol, 2020 Oct 29

American journal of hematology, 2019-11

J Clin Oncol, 2011 Jan 31

J Natl Compr Canc Netw,

Lancet Haematol,

Leukemia, 2020 Jul 21

Clin Lymphoma Myeloma Leuk, 2020 Jul 29

N Engl J Med,

American journal of hematology, 2019-05

Blood Cancer J, 2022 Sep 14

Blood, 2018-01-11

Blood,

N Engl J Med,

Clin Cancer Res, 2022 May 02

Lancet, 2021 Jun 24

Blood, 2022 Jan 27

Transpl Infect Dis, 2015 Sep 26

Clin Lymphoma Myeloma Leuk, 2021 Feb 07

Lancet, 1994 Apr 30

Lancet Haematol, 2019 Jul 18

Lancet Haematol, 2019 Jul 18

Br J Haematol, 2021 Jun 10

Blood, 2022 Oct 20

Lancet Oncol, 2021 Nov 11

J Clin Oncol, 2022 May 23

Blood Cancer J, 2022 Jan 31

Blood advances, 2020 Dec 08

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2021 Dec 13

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2022 Apr 04

The Lancet. Haematology, 2023 Sep 27

N Engl J Med, 2022 Jun 05

British journal of clinical pharmacology, 2010 May

Transplantation and cellular therapy, 2022 Dec 06