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Medical Oncology

Myeloma   

Questions discussed in this category

How do you approach patients with AL amyloidosis with t(11;14) who have not achieved a hematologic complete response to induction therapy with 6 cycles of Dara-CyBorD?
Specifically, in the setting of patients that have had a PR or VGPR and are not actively progressing. 
1 Answer available
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
When do you consider bispecific antibodies?
1 Answer available
In a patient with history of recurrent VTE despite anticoagulation, would you consider lenalidomide as part of your initial myeloma regimen?
2 Answers available
What is your current practice for de-escalation of frequency of administration of bispecific antibodies among responders in patients with relapsed/refractory multiple myeloma?
1 Answer available
How does one interpret an SPEP showing potentially obscured but non-quantifiable M-spike however an IFE showing monoclonal protein?
Can you elaborate on reasons for a non-quantifiable SPEP and how does one follow the paraprotein?
3 Answers available
Does the presence of osteoporosis change the extent of workup that should be performed for an older patient with otherwise serologically low-risk MGUS?
Would your considerations change for a man vs a woman?
1 Answer available
Is there a role for CRS prophylaxis with tocilizumab during bispecific T cell engager initiation for myeloma?
Are there specific scenarios where it could be considered?
1 Answer available
How do you evaluate a patient with MGUS and peripheral neuropathy?
Can you explain when would you consider light chain amyloidosis work up with fat pad biopsy?
1 Answer available
How do you approach pelvic radiation therapy for a patient with multiple myeloma who needs more intensive therapy (e.g., Dara-KRd or impending CAR-T) with a risk of cytopenias?
For example, a large iliac or sacral plasmacytoma causing symptoms. Both medical oncologists and radiation oncologists get nervous about RT-related cy...
1 Answer available
How often do you assess for frailty in your clinical practice for patients with Multiple Myeloma and what tool do you use?
For example: eyeball test, simplified frailty assessment (Facon et al.), IMWG frailty score, ECOG only?
1 Answer available
How do you approach treatment for patients with proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) with end-stage renal disease who are considering kidney transplant?
Most patients with PGNMID have no detectable disease in their marrow or blood and urine protein cannot adequately be monitored.
1 Answer available
Does the degree of elevation in free light chains/ratio correlate with a probability of AL amyloidosis?
Does a certain level of free light chain ratio reassure you against the possibility of AL amyloid? Is there a certain level that makes you more concer...
1 Answer available
What is your preferred approach to a patient with myeloma who has refractory disease to Dara-VRd in the frontline setting?
2 Answers available
How are you dosing IVIG following BCMA CAR-T or bispecific antibodies in multiple myeloma?
Do you only offer it for patients with a documented IgG < 400? Do you check the IgG at all, or are you doing primary prophylaxis?
1 Answer available
How do you approach initial treatment for AL amyloidosis with excess plasmacytosis in the bone marrow, that has cardiac involvement and is not a transplant candidate?
Let's assume they have cardiac involvement and transplant may not be feasible. 
1 Answer available
How would you approach dose modifications and/or frequency of lenalidomide in patients with advanced renal impairment (eGFR <30)?
The FDA package insert suggests 2.5 mg daily in these settings, while the PrE1003 study demonstrated that a higher dose is feasible. Many oncologists ...
2 Answers available
What is your approach to determining fitness for patients to undergo CAR-T therapy for relapsed/refractory multiple myeloma, and any absolute perceived contraindications for CAR-T?
1 Answer available
In what scenarios (if ever) would you check peripheral blood flow cytometry in a patient with known multiple myeloma to evaluate for circulating plasma cells (CPCs) in the absence of an abnormal smear?
There are some retrospective data that CPCs are associated with worsened outcomes after transplantation. Anecdotally, CPCs could be collected as part ...
1 Answer available
How do you monitor multiple myeloma in patients receiving dialysis?
Since free light chains are removed by dialysis and SPEP can also be impacted, is there a reliable way to monitor patients with ESRD and MM?
1 Answer available
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?
E.g. frequency of Bortezomib, dosing of Bortezomib, length of cycles.
1 Answer available
Based on the DREAMM-7 and DREAMM-8 data, if approved again in the US, how would you incorporate belantamab mafadotin in your practice?
2 Answers available
Based on the IMROZ and BENEFIT data, would you recommend quadruplet therapy for non transplant eligible newly diagnosed multiple myeloma?
1 Answer available
With the recent approvals of CAR-T for second-line therapy in myeloma, does this change your approach to use of consolidative autologous transplant or autologous transplant as second line therapy?
2 Answers available
In 2024, do you consider isolated gain(1q) [not amp(1q)] to be a high-risk cytogenetic abnormality in multiple myeloma?
Most would argue that gain(1q) in combination with another high-risk feature constitutes ultra-high-risk multiple myeloma, and most would argue (with ...
1 Answer available
What is your threshold to diagnose light chain MGUS with only a slight elevation in the light chain ratio, in a patient without other CRAB symptoms and no M spike?
When would you consider a bone marrow biopsy?
4 Answers available
How long should we treat patients with newly diagnosed myeloma with bisphosphonates or RANKL inhibitors for their myeloma bone disease given recent data?
The OS benefit with Zometa was seen only in patients with myeloma bone disease achieving less than or equal to a partial response. SRE risk reduction ...
1 Answer available
Is there any value to getting a bone marrow biopsy at the time of biochemical relapse in multiple myeloma before switching to a new line of therapy?
For many clinical trials, a screening bone marrow biopsy is necessary to get a new baseline. Do you do the same in real-world practice?
3 Answers available
Do you resume zoledronic acid or denosumab at relapse in multiple myeloma?
Previous questions have focused on the newly diagnosed setting and choice of bisphosphonate versus denosumab. IMWG guidelines do recommend resuming zo...
2 Answers available
In the current myeloma landscape, do you make treatment decisions based on MRD results, either for MRD negativity or MRD resurgence?
2 Answers available
How do you utilize immunoglobulin testing to affect treatment decisions in patients with myeloma?
What does it add beyond a serum electrophoresis or light chain testing? Are there certain types of patients where monitoring immunoglobulins is parti...
1 Answer available
For patients on commercial teclistamab who achieve a response, are there patient-specific or response-specific parameters that would prompt you to de-escalate therapy from once per week?
For example - minimum number of months of therapy, driving distance to clinic, at least a CR with or without MRD negativity?
3 Answers available
How do you discuss harms of MGUS screening with other medical providers?
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...
2 Answers available
For a Jehovah's Witness patient with multiple myeloma, could you safely offer a BCMA-directed bispecific antibody or CAR-T therapy?
Please assume that IVIG is fine (as it is for many Jehovah's Witness patients, since IgG is often not considered a blood product per se).
2 Answers available
What induction regimen do you choose for high risk newly diagnosed multiple myeloma in light of the recent high risk focused studies?
4 Answers available
Are there any circumstances where you recommend early institution of systemic therapy for patients with solitary plasmacytoma?
Specifically, do you offer closer follow-up for certain patients after local radiation?
3 Answers available
For otherwise transplant-eligible patients with myeloma, given developments of bispecifics and CAR-T, what is your age cutoff for consolidative autologous transplant?
Would you transplant a patient over the age of 70 with newly diagnosed myeloma? Does the risk category impact your decision?
2 Answers available
What is your approach to vaccinations and titers for patients with myeloma, who are immunosuppressed and do not have appropriate antibody responses to vaccines?
E.g., for a patient with myeloma, s/p induction therapy, and high-dose chemotherapy, followed by autologous rescue with inappropriate antibody respons...
3 Answers available
Would you recommend radiation to a painful rib fracture in a patient with multiple myeloma on systemic therapy with ongoing response to treatment?
Is there benefit to radiation on top of systemic therapy?
5 Answers available
How do you approach the initial dosing of carfilzomib for patients with relapsed multiple myeloma?
Is the therapeutic purpose of the proteasome inhibitor to maximize total dosage per week or number of infusions per week?
2 Answers available
How extensive of a workup do you do for systemic AL amyloidosis for a patient with a resected amyloidoma, localized AL amyloid deposition in their airway or lungs, who has no other symptoms?
Would you do a 24-hour urine and echocardiogram in all of these patients? Cardiac biomarkers, PT/PTT, or any other such blood tests?
3 Answers available
How would you approach the treatment of an elderly patient with multiple myeloma and CALR+ myelofibrosis with elevated platelets?
Presuming the patient is not a transplant candidate due to comorbidities, PS, and age.
1 Answer available
What factors do you look at while deciding between a daratumumab-based quadruplet induction versus standard triplet induction such as VRd for newly diagnosed MM?
2 Answers available
How is monoclonal gammopathy of renal significance (MGRS) different from myeloma kidney?
If there are light chain deposits on the kidney, is that conclusive of MGRS?
1 Answer available
For a patient with triple-class-refractory myeloma and cytopenias who has been collected for CAR-T, would you choose aggressive chemotherapy or a bispecific antibody for bridging?
This question seems quite specific but happens quite often. Multi-drug chemotherapy runs the risk of profound cytopenias and infections, while bispeci...
2 Answers available
With the CANOVA results in mind, would you continue using venetoclax in patients with multiple myeloma with t(11;14)?
1 Answer available
What is your approach to mitigating the infection risk with bispecific antibodies in multiple myeloma?
4 Answers available
How would you manage a patient with new renal failure and mild anemia in the setting of a moderate M-Spike and low kappa/lambda ratio, but with negative PET and bone marrow with <10% plasma cells?
1 Answer available
What is your approach to MRD testing in the frontline treatment of multiple myeloma?
How frequently and what type of testing/sample are you performing MRD assessment? Does your approach differ between transplant-eligible and transplan...
1 Answer available
How do you choose between the different recently approved Bispecifics Antibodies for Relapsed/Refractory Multiple Myeloma?
I.e. dosing regimen frequency, side effect profile, duration of follow up, etc.
3 Answers available
For patients who require aggressive debulking in multiple myeloma, what is your preferred chemotherapy regimen and why?
Modified HyperCVAD? V(R)D-PACE? DCEP? Are there any data to favor one over the other?
2 Answers available
How do you manage IgM related peripheral neuropathy?
Do you utilize rituximab or any other specific management strategies?
2 Answers available
How would you approach BCMA-directed therapy in a patient with myeloma and renal failure on dialysis?
Would you prefer CAR-T or bi-specific or neither? If CAR-T, how do you approach lymphodepletion? 
2 Answers available
What are alternative myeloma therapies for patients who are unable to afford lenalidomide or oral cyclophosphamide due to gaps in prescription drug coverage?
Several patients with inability to access oral cyclophosphamide or lenalidomide, have attempted assistance and grants to no avail.
1 Answer available
What post-auto maintenance therapy do you recommend for patients with high-risk multiple myeloma?
Given recent retrospective study showing potential lack of benefit with bortezomib-based maintenance therapy (Bumma et al., PMID 37021929).High-risk a...
1 Answer available
How do you approach post-transplant maintenance for patients with high-risk myeloma?
Which PI and at what dosing intervals? Dexamethasone or not? Emory has now published data with VRd consolidation as well as KPd consolidation, while ...
2 Answers available
What are your top takeaways in Hematologic Malignancies from ASCO 2023?
8 Answers available
Do you recommend routinely getting periodic 24-hour urine monoclonal protein study for patients with active multiple myeloma?
If so, why?
4 Answers available
Would you implement CAR-T therapy earlier in practice if approved in earlier lines for multiple myeloma based on the KarMMa-3 and CARTITUTUDE-4 studies?
3 Answers available
How would you approach a patient with solitary plasmacytoma with an FLC ratio >100, but a negative bone marrow biopsy and negative PET-CT?
2 Answers available
Is a bone marrow biopsy necessary in a patient with a previous tissue diagnosis of plasmacytoma or smoldering multiple myeloma, who now meets criteria for active myeloma?
Assuming there is clear laboratory and/or imaging evidence of disease progression, and assuming FISH data is already available from a prior biopsy, do...
1 Answer available
Do you have any concerns about using checkpoint inhibitors in a patient with myeloma who has a second malignancy?
Patient with stable disease on maintenance therapy with lenalidomide and dexamethasone
2 Answers available
Do you always start treatment for patients who meet diagnostic criteria for multiple myeloma by SLiM criteria alone?
i.e., 60+% bone marrow plasmacytosis, light chain ratio >100, and/or >1 MRI lesion
2 Answers available
What would be your next step in workup for a patient with IgG Kappa Monoclonal protein detected on SPEP and free lambda light chains found in the urine, with chronic diarrhea for 3 years and concern for GI amyloidosis?
1 Answer available
How would you treat a patient with two concurrent plasmacytomas whose bone marrow showed no evidence of multiple myeloma and has no other MM defining features?
Normal CBC, CMP, SPEP, serum light chains, and FISH. Young otherwise fit patient.
3 Answers available
Do you routinely prescribe PPI prophylaxis for myeloma patients who will be on low-dose aspirin and weekly dexamethasone?
1 Answer available
Do you change treatment for confirmed biochemical progression in patients with otherwise secretory MM even if the M-spike is <0.5 g/dL?
3 Answers available
Are there situations where you would start treatment for cardiac amyloid in a patient with amyloid seen on biopsy, but still pending mass spectrometry results?
E.g. in a patient with tenuous cardiac function, would starting treatment several weeks earlier potentially improve outcomes?
1 Answer available
How would you approach grade 2 neurologic toxicity in a patient on daratumumab, dexamethasone, and lenalidomide for relapsed multiple myeloma?
Regimen currently 25 mg lenalidomide D1-21 of D28 day cycles, Daratumumab 16 mg/kg every 2 weeks.
1 Answer available
What is your approach to maintenance therapy post autologous stem cell transplant for patients with concurrent multiple myeloma and AL amyloidosis?
Does your choice of agent differ, or are you more or less likely to offer maintenance than if the patient had multiple myeloma alone?
2 Answers available
Do you check beta 2 microglobulin in patients with MGUS?
Does it assist in prognosis in any way?
1 Answer available
Is there still a role for plasma exchange/PLEX for confirmed or suspected cast nephropathy in multiple myeloma to rapidly reduce light chain burden?
In addition to reversing hypercalcemia, initiating myeloma therapy, etc.
1 Answer available
For a patient with MM progressing on a daratumumab-based regimen, is it preferable to entirely switch drug class or is another monoclonal antibody such as isatuximab an acceptable next step?
5 Answers available
What would you use for a maintenance regimen after high dose chemotherapy and autologous stem cell transplant for a patient with 17p-deleted multiple myeloma?
1 Answer available
Assuming all options for BCMA-directed therapy are available, how would you approach treatment for a patient with 4 prior lines of myeloma-directed therapy who is eligible for a BCMA-directed therapy?
Ide-cel? Cilta-cel? Teclistamab?
1 Answer available
For patients with IgG kappa multiple myeloma receiving an IgG kappa mAb (i.e., daratumumab), how important is it clinically to use an interference assay if they're in a VGPR to see if their M-spike might actually be 0?
For example, would you use a tool like the Hydrashift assay? Would this change your management? 
1 Answer available
When you use selinexor for relapsed/refractory myeloma, with what total weekly dose do you practically start?
If tolerated through Cycle #1, how aggressively do you try to titrate the selinexor dose up toward 100mg weekly or 80mg twice-weekly? And does your a...
1 Answer available
Do you offer IVIG to myeloma patients with recurrent infections?
Do you have a certain immunoglobulin level which you would use to determine this?
1 Answer available
What is your approach for using anticoagulation/aspirin in patients with multiple myeloma?
2 Answers available
Would you substitute carfilzomib in place of bortezomib in a transplant-eligible AL amyloidosis patient with baseline amyloid neuropathy and worsening neuropathy on bortezomib despite maximal dose reduction?
2 Answers available
For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?
1 Answer available
What is your preferred up-front treatment for transplant-eligible patients with primary (de novo) plasma cell leukemia?
2 Answers available
What is your approach to pRBC transfusion support for myeloma-related anemia?
How much weight do you give to a hgb/hct threshold versus symptoms?
3 Answers available
What are your takeaways from the GPRC5D-Targeted CAR-T trial (Mailankody et al. NEJM Sept 2022) and any key differences compared to the BCMA directed products?
1 Answer available
How do you approach work-up for a patient suspected for monoclonal gammopathy of renal significance for whom renal biopsy is contraindicated?
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?
2 Answers available
If you treat a patient with high-risk smoldering myeloma on trial and they develop biochemical progression by M-spike, but still no CRAB-SLiM criteria, what would you do next?
In this case, the patient had received daratumumab/lenalidomide/dexamethasone as part of a cooperative group trial. Would you say that the patient had...
1 Answer available
Is there a role for repeat CAR-T with a potentially different product in relapsed and refractory multiple myeloma?
2 Answers available
Do you recommend IVIg and/or cytoreduction for patients with IgM MGUS with reciprocal depression in IgG and recurrent infections?
Infection is not part of the criteria for starting treatment both in UpToDate and in NCCN guidelines. 
1 Answer available
Do you perform a periodic PET CT to screen for extramedullary disease in patients with MM who are in remission?
2 Answers available
Where does Elotuzumab-based combination therapy, specifically EPd, fit in your treatment paradigm for relapsed MM?
Does sequence matter?
1 Answer available
What induction regimen would you choose for a patient with newly diagnosed multiple myeloma with incidental amyloidosis noted on bone marrow biopsy, but with no end-organ damage as a result of amyloid deposition?
Would you consider Dara-CyBorD or a MM triplet/quadruplet such as VRd or Dara-VRd? 
4 Answers available
Would you add Daratumumab to upfront treatment of multiple myeloma in a patient with tetraploidy on FISH?
1 Answer available
How do you approach treating a patient with IgM-AL amyloidosis?
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...
3 Answers available
How do you approach treatment for a patient with a biochemical relapse while on maintenance lenalidomide after autologous stem cell transplant for multiple myeloma?
What factors (i.e. timing from transplant, dose, prior therapy) impact your decision? 
1 Answer available
What is your preferred first line regimen for myeloma with severe renal impairment, either on or off dialysis?
1 Answer available
In transplant-eligible, fit patients with primary refractory myeloma, what is the optimal timing for stem cell collection?
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...
3 Answers available
How do you now approach treatment sequencing in MM in light of the DETERMINATION trial data?
Do the results change your clinical practice?
2 Answers available
How do you approach the decision to pursue early versus delayed autologous stem cell transplantation in newly diagnosed multiple myeloma?
1 Answer available
At this time, how are you using MRD testing for clinical management of patients with multiple myeloma?
1 Answer available
Would you consider CAR-T therapy without autologous transplant in a patient with multiple myeloma whose best response to induction therapy is a partial response?
1 Answer available
What is your approach to treating newly diagnosed plasma cell leukemia?
1 Answer available
In a patient diagnosed with Multiple Myeloma, is there a role for 24-hour UPEP prior to treatment?
Does measuring serum free-light chains make a 24-hour UPEP unnecessary?
1 Answer available
How would you approach therapy for a patient with smoldering multiple myeloma whose light chain ratio has increased to greater than 100 over several years in the absence of any other myeloma-defining events?
Does a progressing kappa/lambda ratio > 100 at any point in time warrant treatment, or does one wait to treat patients in the setting of a slowly i...
2 Answers available
For a patient with concurrent diagnoses of Hodgkin Lymphoma and Light Chain Myeloma complicated by Myeloma Kidney, how would you approach treatment?
What agents would have sufficient efficacy overlap to treat both?
2 Answers available
What would be your approach to initial treatment of a patient with standard-risk myeloma unwilling to undergo autologous stem cell transplant, if practicing in a resource-limited setting?
1 Answer available
For relapsed/refractory myeloma, how long of a disease-free interval from first autologous transplant do you recommend before considering a second autologous transplant?
1 Answer available
What induction combination(s) would be appropriate for newly diagnosed standard cytogenetic risk multiple myeloma who have a transplanted kidney?
Would you avoid imid's given reported association with transplant rejection?
1 Answer available
For patients with mild CKD, how do you decide between zoledronic acid and denosumab for bone protection in patients with multiple myeloma?
For pts w/ eGFR between 30-60
1 Answer available
What is your experience with using Frailty Index or other geriatric screening in making decisions for elderly patients with multiple myeloma?
Frailty Index per Palumbo et al. PMID 25628469Is it practical to apply in clinics? Have you made decision changes based on it?
2 Answers available
In what clinical scenarios do you utilize venetoclax-based therapy in relapsed/refractory multiple myeloma?
Venetoclax has demonstrated efficacy in patients harboring t(11;14) mutations but is not FDA approved for MM. Can you expand on what situations you ma...
3 Answers available
When would you add daratumumab to a PI/IMiD/dex backbone for first-line treatment of transplant-eligible multiple myeloma?
Are the early results of CASSIOPEIA (Abst 8003) from ASCO 2019 practice changing? What about the GRIFFIN results in 2020?
2 Answers available
For patients with myeloma on an IMiD, how do you decide on the dosages of aspirin or anticoagulants in VTE prophylaxis ?
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...
1 Answer available
How do you approach patients with recurrent grade 3+ neutropenia on IMiD-containing regimens (e.g., VRd or KRd) beyond dose reductions?
For example: shorten IMiD duration each cycle, add scheduled G-CSF, add antibacterial prophylaxis, etc.
1 Answer available
What infectious prophylaxis do you use for patients with newly diagnosed multiple myeloma?
How do you decide how long to continue?
1 Answer available
What is your treatment of choice for triple class refractory multiple myeloma?
CAR-T (any specific preference of product?) vs bispecific antibodies vs any other specific agents not previously utilized?
2 Answers available
How does one interpret persistently positive lambda light chains on serum immunofixation but without measurable serum monoclonal protein and a normal light chains and ratio?
Is a repeatedly abnormal serum immunofixation all it takes for MGUS?
2 Answers available
What options are available for patients with relapsed/refractory AL amyloidosis after Dara-CyBorD, other than clinical trial?
1 Answer available
Which patients with smoldering myeloma do you treat?
2 Answers available
How would one alter therapy in a transplant-ineligible AL amyloidosis with less than a complete response to six cycles of Dara-CyBorD?
Would you continue with daratumumab maintenance per ANDROMEDA or switch regimen?
2 Answers available
How do you approach transplant eligible myeloma patients with a partial or minimal response to treatment with 3-4 cycles of RVD?
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...
1 Answer available
What is the optimal prophylaxis regimen to use prior to a selinexor based regimen in the treatment of multiple myeloma for nausea and electrolyte abnormalities? 
2 Answers available
Would you re-challenge a patient with refractory multiple myeloma with carfilzomib who responded well but developed grade 3 heart failure and subsequently recovered the EF upon holding carfilzomib?
If you do recommend resuming carfilzomib, what dose and frequency would you use?
1 Answer available
How do you approach a patient with an anaplastic plasmacytoma without systemic evidence of disease in the bone marrow?
What about multiple anaplastic plasmacytoma without bone marrow involvement?
2 Answers available
Do you recommend work up for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
Can you expand on this by sharing exactly what this routine workup should include? What additional tests outside of evaluating for POEMS and amyloidos...
2 Answers available
For young patients with smoldering multiple myeloma who wish to be treated with lenalidomide, how do you go about harvesting their cells for an autologous transplant?
Insurance won't pay for harvesting if the transplant is not done within a year.
2 Answers available
Does multiple myeloma become more radioresistant post transplant?
2 Answers available
How do you utilize serum viscosity in the clinical management of plasma cell disorders?
1 Answer available
Do you continue bortezomib past 8 cycles for transplant ineligible patients with multiple myeloma on VRd who are tolerating therapy well with no neuropathy?
Would you use MRD status to guide your decision making? 
1 Answer available
Would you move to a venetoclax-based regimen for a patient with pentarefractory MM and t(11;14) translocation, previously treated with bortezomib and carfilzomib?
If so, venetoclax/dexamethasone by itself or do you include a PI?
2 Answers available
Do you routinely offer a bisphosphonate or denosumab to multiple myeloma patients without skeletal lesions?
Recommendations in guidelines are discordant (ASCO vs NCCN vs UptoDate).
2 Answers available
How do you counsel patients referred for abnormal light chain ratio when individual light chains are in normal range?
2 Answers available
What is your preferred maintenance strategy for high risk multiple myeloma?
2 Answers available
Should patients with active multiple myeloma and other gammopathies be routinely vaccinated against herpes zoster?
If yes would you delay initiation of antineoplastic therapy to allow time for the vaccine to start acting?
1 Answer available
How do you counsel patients with newly diagnosed transplant-ineligible multiple myeloma on the expectations of treatment in terms of disease control, duration of therapy, monitoring and follow up?
3 Answers available
What level of 24h urine M protein do you consider to define active myeloma in a patient with renal insufficiency, proteinuria and monoclonal gammopathy?
When do you start treatment in this case?
1 Answer available
What would be your preferred second line treatment for a frail elderly patient progressing on Rd?
1 Answer available
How do you determine when to use a maintenance regimen vs continuous 3-drug regimen in a transplant-ineligible MM patient after response to first line therapy?
How is this impacted by patient features, cytogenetics/disease biology, depth of response, or other factors? What would compel you to continue 3 drugs...
3 Answers available
What clinical factors impact your upfront treatment decisions in transplant-ineligible MM?
How do you factor in patient age, frailty, patients with underlying organ dysfunction, or other clinical features? Do you still consider CyBorD or R...
3 Answers available
When, if ever, would you choose a two-drug regimen instead of three drug regimen first line in patients with transplant-ineligible Myeloma?
4 Answers available
What factors besides disease progression would lead you to de-intensify or change MM therapy for a patient with ongoing response?
In your experience, do certain regimens have more cumulative toxicity, financial impact, or patient convenience factors?
3 Answers available
When do you consider re-treatment with lenalidomide in later line therapy for relapsed multiple myeloma?
Are there scenarios where you would use a higher dose of lenalidomide in a novel doublet or triplet (eg. relapse on lenalidomide maintenance)?
1 Answer available
How would you manage multiple myeloma with a suboptimal response to frontline quadruplet therapy?
When would you consider utilizing autologous SCT in those with a PR or SD? Is there a potential role for BCMA-directed CAR-T or bispecific therapy in...
1 Answer available
What is your approach to the treatment of gamma heavy chain disease (Franklin's disease)?
How do you distinguish this entity from other plasma cell disorders (eg. MGUS, MM, etc.)?   Review of literature suggests that most of these pa...
1 Answer available
How do you use daratumumab in the treatment of systemic AL amyloidosis?
What regimens would you consider combining it with? Any specific combinations to avoid or special considerations?
1 Answer available
What would be the ideal patient to receive selinexor-based therapy over other options for penta-refractory multiple myeloma?
Excluding clinical trials
1 Answer available
How do you risk stratify complex karyotype in newly diagnosed multiple myeloma in the absence of specific high-risk cytogenetic abnormalities?
2 Answers available
Why are autoantibodies not often detected on monoclonal gammopathy assays (SPEP/IFE, quantitiative immunoglobulins)?
For example, in cold agglutinin disease or AIHA, antibodies can be detected via DAT, but are often not observed on assays for monoclonal gammopathies.
1 Answer available
How would you treat non-secretory myeloma in an inpatient setting?
Does your management change based on the type of end-organ involvement at the time of diagnosis? Are there any reports of CNS involvement with non-se...
2 Answers available
Is there any benefit in continuing VRd instead of VR as maintenance therapy in transplant ineligible multiple myeloma?
2 Answers available
For patients with cancer receiving a bone-modifying agent (bisphosphonate or denosumab) who suffer a fracture requiring stabilization or reconstruction, how do you manage the bone-modifying agent peri-operatively?
Is there concern for impaired healing? Do you pause therapy and for how long?
1 Answer available
Is there a role for MRD monitoring in the decision to switch from a triplet regimen to maintenance therapy in transplant-ineligible myeloma patients?
1 Answer available
How do you approach treatment in a patient with a solitary plasmacytoma with minimal marrow involvement (< 10% clonal plasma cells)?
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...
2 Answers available
Under what circumstances do you consider double autologous stem cell transplants for patients with multiple myeloma?
4 Answers available
How do you treat newly diagnosed multiple myeloma with 1q gain?
Given the recent reclassification of gain(1q21) as a high risk cytogenetic abnormality, has this changed your practice in managing newly diagnosed pat...
1 Answer available
In a patient with multiple myeloma who cannot tolerate lenalidomide or bortezomib due to GI toxicity, what regimen would you choose for next-line therapy?
Is there evidence for daratumumab-based doublet regimens? Would your choice differ based on the patient's transplant eligibility?
1 Answer available
Do you hold maintenance lenalidomide or bortezomib for a patient who needs a surgery?
For example, for joing replacement surgery? Do you hold the revlimid for certain about of time before and after?
1 Answer available
How do you manage severe lenalidomide-associated drug rash in a transplant-eligible patient with multiple myeloma?
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...
1 Answer available
Is there any role for bisphosphonate or alternative bone-modifying agents use in SMM in the absence of other indications for its use?
1 Answer available
Is there any role for early stem cell mobilization and collection during the SMM phase?
Do you worry about the ability to collect stem cells (at the time of progression to MM) if someone with SMM has been on prolonged lenalidomide?
1 Answer available
How long do you treat with IMID in a case of smoldering multiple myeloma?
1 Answer available
Does high risk cytogenetics as a sole abnormality influence your treatment decision for smoldering multiple myeloma?
1 Answer available
How do you treat anaplastic multiple myeloma?
What features are used to distinguish anaplastic multiple myeloma (AMM), and what other conditions should be considered in a differential diagnosis (e...
1 Answer available
Would you consider using daratumumab in the first line setting for non-transplant eligible multiple myeloma?
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...
5 Answers available
How would you manage a patient with a solitary plasmacytoma with a partial response to RT?
Would you recommend surgical resection if feasible? Or just monitor every 3-6 months as NCCN guidelines suggest? Would your management differ based o...
2 Answers available
What is your approach to a patient with systemic AL amyloidosis who has achieved a hematologic response but not an organ response with CyBorD?
Would you proceed to autologous transplant, or switch to an alternate regimen (eg. daratumumab-based) first? Would the type or degree of organ involv...
1 Answer available
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
2 Answers available
Do you perform biomarker-based screening for AL amyloidosis in patients with newly diagnosed MGUS?
If so, what is your approach to laboratory and clinical testing?
1 Answer available
How do you approach the workup and initial treatment of systemic AL amyloidosis?
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...
1 Answer available
How would you decide on VRd vs DRd for initial management of transplant ineligible multiple myeloma?
Are there specific patient groups where you would choose one over the other? Are the cost differences significant enough to dissuade you from choosin...
1 Answer available
How do you manage patients who develop de novo or recurrent skin cancers (SCC or BCC) while on lenalidomide?
Do these events mandate discontinuation of lenalidomide therapy or switching to a different agent? Can appropriate therapy for these skin cancers be r...
1 Answer available
Do you recommend lenalidomide for high risk smoldering multiple myeloma?
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...
1 Answer available
What dosing regimen of carfilzomib do you use in the front line setting for high risk transplant-eligible multiple myeloma?
3 Answers available
In a patient with Waldenstrom's macroglobulinemia doing well and feeling better on ibrutinib & rituximab, but with a rising IgM, do you switch treatment or continue?
1 Answer available
What is your preferred maintenance therapy in young, fit patients with de novo plasma cell leukemia who achieve complete response after autologous stem cell transplantation?
2 Answers available
How do you treat a gastric plasmacytoma which is not amenable to radiation?
1 Answer available
When do you offer consolidative tandem autologous stem cell transplantation for high-risk multiple myeloma?
For example - Would you offer tandem transplantation in a young, fit patient in a CR after first transplant, but with MRD detectable?
1 Answer available
Can post op RT be omitted in a surgically repaired pathological fracture site in multiple myeloma if the patient will receive systemic therapy?
1 Answer available
With recent measles outbreaks occurring in the US, would you consider offering multiple myeloma patients s/p ASCT on maintenance treatment vaccination, or an alternate means of immunity?
Although the MMR vaccine is contraindicated in immunosuppressed patients on anticancer treatment according to CDC/ACIP and IDSA guidelines, data on sa...
1 Answer available
Would detection of an adverse cytogenetic marker such as dup(1q) alone in the setting of MGUS satisfy criteria for a diagnosis of multiple myeloma?
1 Answer available
In transplant-eligible, fit patients with multiple myeloma who have an inadequate response to front-line therapy, what regimen would you choose for second-line?
Given the recent results presented from the Griffin trial, would you choose a daratumumab-based regimen (eg. D-VRd) over other salvage options (V...
1 Answer available
What is your preferred first-line therapy for a patient with standard risk multiple myeloma?
Has the recent data presented at ASH affected your choice of regimen? Would your choice differ between transplant-eligible and transplant-ineligible ...
1 Answer available
Is there a role for assessing measurable/minimal residual disease (MRD) in multiple myeloma at this time?
Would MRD assessments affect your clinical decision making for MM patients outside of a clinical trial?
1 Answer available
When do you choose to give CyBorD over RVd in a newly diagnosed myeloma patient?
Specifically, what regimen would you choose in a patient with new renal failure but not requiring dialysis?
3 Answers available
How do you utilize lenalidomide maintenance in non-transplant eligible myeloma?
Does the choice of initial induction regimen affect your decision for when to employ lenalidomide maintenance? Are there situations where you would c...
1 Answer available
What is your preferred approach to therapy in transplant ineligible multiple myeloma initially treated with CyBorD owing to acute renal failure, after achieving a VGPR (+IFE alone) with continued mild-moderate renal impairment?
Would you change to an alternative triplet therapy, or switch to maintenance therapy? Are there variations in depth of response short of CR that woul...
1 Answer available
What are some preferred steroid sparing regimens for untreated multiple myeloma patients who have type 1 diabetes mellitus?
1 Answer available
What is your preferred approach to the treatment of transplant ineligible multiple myeloma that has been treated with a triplet regimen and reached a plateau phase?
Would you observe until progression or would you place the patient on maintenance?
1 Answer available
How would you approach a patient with smoldering myeloma that has a quickly rising and very high M-spike (6 g/dL range)?
Once you decide to begin treatment, any special precautions you would use for protein levels starting that high.
1 Answer available
Do you ever consider the use of weekly (as opposed to bi-weekly bortezomib) for newly diagnosed multiple myeloma patients who are transplant eligible?
1 Answer available
When treating a patient with multiple myeloma with bortezomib, how do you decide between subcutaneous vs intravenous dosing?
Subq has been shown to have lower risk of neuropathy. Is there any reason to use weekly IV still?
3 Answers available
How would you treat a fit, newly diagnosed, high-risk multiple myeloma patient with multiple poor risk factors and circulating plasma cells?
In a patient with multiple poor risk features including TP53 mutation, 1q amplification, stage III, and circulating plasma cells, would you consider a...
1 Answer available
When do you consider re-starting treatment for a patient with relapsed myeloma?
For example, how significant does the M protein have to increase for you to begin a conversation about new therapy?
2 Answers available
How do you choose among regimens for relapsed refractory myeloma?
Specifically, to you lean towards elotuzumab or a daratumumab-based regimen?
1 Answer available
Given the sensitivity and prognostic value of the serum free light chain ratio for light chain multiple myeloma, do you continue to check urine studies?
2 Answers available
In multiple myeloma patients on bortezomib and dexamethasone, who develop HZV reactivation while on HZV prophylaxis, do you stop bortezomib/dexamethasone permanently?
1 Answer available
If a patient with myeloma develops a symptomatic DVT or PE while on an immunomodulatory drug such as lenalidomide, would you stop the IMiD?
Would you ever give another IMiD?
2 Answers available
How do you manage the development of neuropathy in patients receiving bortezomib for multiple myeloma?
At what point is the neuropathy a contraindication to further bortezomib therapy?
1 Answer available
Has the combination of daratumumab, bortezomib, and dexamethasone been tried for the treatment of plasma cell leukemia?
1 Answer available


Papers discussed in this category

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Leukemia, 2017 Jul 04
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Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel.
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Low expression of hexokinase-2 is associated with false-negative FDG-positron emission tomography in multiple myeloma.
The Lancet. Oncology, 2019-06
International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders.
Lancet, 2019 Jun 03
Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study.
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Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma: the GRIFFIN trial.
Leuk Lymphoma, 2011 Dec 13
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Haematologica, 2019 Oct 03
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Lancet Oncol, 2019 Dec 16
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N Engl J Med,
Oral Selinexor-Dexamethasone for Triple-Class Refractory Multiple Myeloma.
Lancet,
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Lancet, 1994 Apr 30
Randomised trial of intravenous immunoglobulin as prophylaxis against infection in plateau-phase multiple myeloma. The UK Group for Immunoglobulin Replacement Therapy in Multiple Myeloma.
N Engl J Med, 2022 Jun 05
Teclistamab in Relapsed or Refractory Multiple Myeloma.
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