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    • ASH
    • Multiple Myeloma News
    • Myeloma Coach
    • Dec 19, 2019

    ASH 2019: Treatment and Imaging Recommendations in Multiple Myeloma

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At a session of the American Society of Hematology meeting, three prominent myeloma specialists discussed a variety of topics for relapsed or refractory multiple myeloma patients. 

Cristina Gasparetto, MD, Duke University Medical Center, Peter Voorhees, MD, Levine Cancer Institute and moderator Ravi Vij MD, MBA, Washington University School of Medicine answered key questions that present themselves during the course of myeloma treatment. 

The doctors discussed the specifics of making drug choices for patients with various myeloma symptoms and specific pre-treatment regimens. Two things were clear:  First, these doctors do not take treatment choices lightly, and secondly, this was not their first rodeo.

Their conversation was learned and technical but here are a few of the many valuable points made. 

How often should imaging and biopsies be completed? 

PET scans yearly?  No. Often PETs done too frequently are not covered by insurance.  A PET should be done at diagnosis during staging. Possible reasons for PET scans subsequently might include re-staging with disease progression and monitoring of bone involvement. 

Do you do a bone marrow biopsy with every relapse?  No. A bone marrow biopsy, especially later in treatment, doesn’t change the treatment paradigm that much. 

Sometimes, however, a bone marrow biopsy is done to check for cytopenia or to determine whether an 11:14 translocation exists which might indicate the use of Venetoclax.

What medications do you prescribe and when? 

  • Ixazomib (Ninlaro):  used when infusion is difficult for a patient either physically or because of difficulty getting to the infusion center. Ixazomib with Lenalidomide and dexamethazone are an oral combination that works well in these cases. 
  • Elotuzumab: used more often when there is concern about disease progression. Slow progression, probably not.  With faster progression, it would be paired with Pomalidomide. Pace of progression is key. A patient progressing slowly should be treated differently than one progressing at a fast pace. 
  • Carfilzomib:  used for an aggressive relapse or for high risk patients. Some would choose Darzalex before Carfilzomib. But there is not just one right answer.
  • Panobinostat (Farydak):  possibly used if the patient has not been heavily treated, but not often. 
  • Bedamustine:  Not often but when used it is prescribed monthly. 
  • Selinexor:  prescribed  off label- with weekly dosing rather than the prescribed dosing every two weeks.
  • Venetoclax:  prescribed  off label for 11:14 patients. (Patients whose bone marrow results show an 11:14 translocation).The Venetoclax, Carfilzomib, & Dexamethasone triplet appears to work well for patients with an 11:14 translocation.  
  • VDT PACE:  If a patient is young and high risk and not able to do a trial it may be used to get them to the next drug approval. It would just be for a short term bridge while the next step is planned. VDT PACE is very difficult. More so even than a transplant. 
  • Iberdomide: The doctors also mentioned some drugs in development including Iberdomide, the next generation “imid” by Celgene which often works even after lenolidomide, pomalidomide and proteasome inhibitors have stopped working.  

What about a second  transplant?

Sometimes a salvage transplant is done to get counts better so a patient can get into a study. A second transplant generally does not last especially after multiple lines of therapy.   

It seemed clear that the doctors take careful consideration before making treatment choices.  This observer was suitably impressed.  Another high score for the incredible value of ASH. 

 

Thank you to our Myeloma Coach ASH 2019 sponsors: 

   

 

About Author

Vicki Jones

I’ve been fighting Multiple Myeloma for more than 15 years. I’ve been on pretty much every approved drug regimen and they’ve all worked really well for me. But of course nothing works forever. Other than some minor fatigue and some of the normal side effects of being 66, I’m feeling great!  My husband and I live in Spokane Washington but spend our winters in Lake Havasu City Arizona. I’ve recently retired from a career as a CPA. Being a Myeloma Coach is a new found joy.

8 Comments

  1. TMC December 28, 2019 at 9:33 am

    I am 65 , diagnosed in 2013. so have been fighting MM for about 7 years and have been on many of the drug regimens also. I just finished DTPACE (good response) and now on elotuzamab/Pomalyst /Velcade. good response so far. Hope it keeps MM quiet for awhile. Have you done CAR-t therapy?

    • Vicki Jones
      Vicki Jones December 29, 2019 at 2:31 pm

      I have not done any trials yet. I know researchers are working hard to extend the responses to car-t. There are many promising therapies in trials now. Have you input your data in Health Tree? It’s a great way to find out which trials you qualify for. The folks at Myeloma Crowd are helping me input my 15 years worth.

    • Mary January 24, 2020 at 11:08 am

      Hello
      My doctor has now proposed VDT PACE for me. I was diagnosed in December of 2018. I have had 3 treatments so far with no success. VRD, DVD and KRD. I am very nervous about this new treatment. Can you tell me about it? Did you have a SCT?

      • Jenny A
        Jenny A January 25, 2020 at 9:07 am

        Hi Mary, I did D-PACE before my tandem transplants. I also did VTD post transplants. Are you seeing a myeloma specialist? That is the best thing you can do for yourself. If you need help finding one, I can help.

  2. Sara Burkart December 29, 2019 at 6:18 am

    Thank you Vicki for the article. My husband is 45 and was diagnosed this year. We live in Lake Havasu!

    • Vicki Jones
      Vicki Jones December 29, 2019 at 7:41 am

      Sara, I’m sorry to hear about your husband’s diagnosis. 45 is young! I was 51 and that was considered young too. If you could use a Myeloma coach, I’m here for you guys! Coaching is completely tailored to your needs. It can be anything from one conversation to on-going support. It can be for the patient, for you, as caregiver, or for both of you. You can find me on the Myeloma Crowd website. There is so much to know.

  3. Paula December 29, 2019 at 7:27 pm

    Diagnosed in 3/12; SCT 9/12; CR 9/12; no maintenance; no meat; pray and very positive.

  4. Enna Woolford January 9, 2020 at 3:51 pm

    Hi Vicki thanks for the article. Good to know the Drs are thorough and thoughtful about choosing treatments.
    Congrats on reaching 15 years!
    That’s great you are only mildly tired and feeling your age your life sounds idyllic- lovely.
    Just wondering are you on any medication ?
    Do you have any tips as to how you are succeeding to be so “ normal”?
    I’m 66 too but MM impacts me more.
    I would love to feel more my normal self. Had SCT July 2019 now on maintenance .
    Enna

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