Myeloma   

Questions discussed in this category



Most would argue that gain(1q) in combination with another high-risk feature constitutes ultra-high-risk multiple myeloma, and most would argue (with ...

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 ...

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?

Previous questions have focused on the newly diagnosed setting and choice of bisphosphonate versus denosumab. IMWG guidelines do recommend resuming zo...

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?

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...

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).

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...

This question seems quite specific but happens quite often. Multi-drug chemotherapy runs the risk of profound cytopenias and infections, while bispeci...

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

Do you utilize rituximab or any other specific management strategies?

Would you prefer CAR-T or bi-specific or neither? If CAR-T, how do you approach lymphodepletion? 

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?

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

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...

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

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

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?

In this case, the patient had received daratumumab/lenalidomide/dexamethasone as part of a cooperative group trial. Would you say that the patient had...

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...

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...

Frailty Index per Palumbo et al. PMID 25628469Is it practical to apply in clinics? Have you made decision changes based on it?

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...

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...

For example: shorten IMiD duration each cycle, add scheduled G-CSF, add antibacterial prophylaxis, etc.

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)?

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?

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...

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


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Leukemia, 2020 Jul 21

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Leukemia, 2022 Apr 11

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American journal of hematology, 2019-05

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Leukemia, 2015 Oct 07

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