Myeloma   

Questions discussed in this category



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...

How much weight do you give to a hgb/hct threshold versus symptoms?

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

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...

Do you opt for VRd, DaraRD, CyBorD or another regimen?  How would this change for a patient with high risk cytogenetics?

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)?

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...

How do you distinguish this entity from other plasma cell disorders (eg. MGUS, MM, etc.)?   Review of literature suggests that most of these pa...

What regimens would you consider combining it with? Any specific combinations to avoid or special considerations?

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

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...

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...

Given the recent reclassification of gain(1q21) as a high risk cytogenetic abnormality, has this changed your practice in managing newly diagnosed pat...

Is there evidence for daratumumab-based doublet regimens? Would your choice differ based on the patient's transplant eligibility?

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

Does your choice of agent differ, or are you more or less likely to offer maintenance than if the patient had multiple myeloma alone?

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...

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?

What features are used to distinguish anaplastic multiple myeloma (AMM), and what other conditions should be considered in a differential diagnosis (e...

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 recommend surgical resection if feasible? Or just monitor every 3-6 months as NCCN guidelines suggest? Would your management differ based o...

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...

Are there specific patient groups where you would choose one over the other? Are the cost differences significant enough to dissuade you from choosin...

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...

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...

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...

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...

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

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

N. Engl. J. Med.,

Leukemia, 2014-03

The Lancet. Oncology, 2014-03

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

Leukemia, 2019-01

BMC Cancer, 2006 May 05

International journal of radiation oncology, biology, physics, 2001-05-01

International journal of radiation oncology, biology, physics, 1998-07-15

Blood cancer journal, 2018-06-12

Leukemia, 2013-08

J. Clin. Oncol., 2019 Oct 25

Clinical lymphoma, myeloma & leukemia, 2016-09

Leuk. Lymphoma, 2011 Feb 08

Cancer,

Leukemia, 2009-10

Ann. Allergy Asthma Immunol., 2019 Aug 07

Clin Lymphoma Myeloma Leuk,

Blood, 2012-01-05

Lancet (London, England), 2019-01-19

The Lancet. Oncology, 2019-01

Lancet Haematol, 2020 Apr 30

Leukemia, 2017 Jul 04

Clin Lymphoma Myeloma Leuk, 2020 Mar 06

J Hematol Oncol, 2018 Jan 16

Blood, 2017-07-06

The Lancet. Oncology, 2019-06

Lancet, 2019 Jun 03

Blood,

Leuk Lymphoma, 2011 Dec 13

Haematologica, 2019 Oct 03

Ann Hematol, 2020 Apr 19

Lancet Oncol, 2019 Dec 16

N Engl J Med,

Lancet,

Blood, 2007-01-15

Blood,

Blood, 2017 Jan 27

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

Blood Cancer J, 2021 May 12

Leuk Lymphoma, 2019 Nov 18

J Clin Oncol, 2012 Jul 16

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

The Lancet. Oncology, 2019-06

Lancet Oncol,

Strahlenther Onkol, 2017 Jun 01

Nature communications, 2019-04-23

Blood, 2012 Aug 13

J Clin Oncol, 2020 Apr 16

Blood,

Blood,

N Engl J Med,

The New England journal of medicine, 2018-11-08

Eur J Haematol, 2021 Aug 11

Lancet Oncol, 2020 Oct 29

Blood Adv, 2021 Sep 01

Cell,

Am J Hematol, 2021 Jul 05

The Lancet. Oncology, 2018-07

Blood Cancer J, 2020 Mar 09

JAMA Oncol,

JAMA, 2016-11-15

N Engl J Med,

J Clin Oncol, 2019 Apr 10

J Clin Oncol, 2020 Feb 21

J Clin Oncol, 2020 Oct 06

JCO Oncol Pract, 2020 Aug 21

Mayo Clin Proc,

Neurol Sci, 2021 Sep 16

Journal of clinical pathology, 2017-09

Leukemia, 2018-06

Clin Lymphoma Myeloma Leuk, 2020 Mar 07

Clin Lymphoma Myeloma Leuk, 2021 Jul 18

Blood Cancer J, 2021 Jan 11

N Engl J Med,

JAMA Oncol,