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?

Topics: Hematologic Malignancies • Medical Oncology • Myeloma • NCI-CCC Tumor Board Question • University of Washington • NCI-CCC Myeloma Tumor Board Question

In this case, the patient had received daratumumab/lenalidomide/dexamethasone as part of a cooperative group trial. Would you say that the patient had had true MM all along in terms of obtaining insurance authorization for autologous transplantation? Would you count this as a line of therapy counting toward CAR-T therapy?

Answer from: Medical Oncologist at Academic Institution

My personal preference is to not treat smoldering myeloma.One of the reasons for this is you fall into this very conundrum.The decision to treat was made while the patient was asymptomatic and without end-organ damage. The patient is now in the exact same scenario, so why should the decision-making ...

Comments

Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center
Could not agree more strongly - I'm all about clin...

Related Questions