Shaji Kumar, MD

Shaji K. Kumar, MD, professor of medicine, Mayo Clinic, discusses the impact of newer treatment regimens for patients with multiple myeloma and his key takeaways from the current landscape.

There’s been a lot of progress in the field of multiple myeloma, and many new agents have been introduced, but the management of these patients will need to shift to include these combination regimens.

Kumar says we want combination regimens that can provide the maximum depth of response or the best response with frontline therapy so that transplant can be used as needed, along with supportive care. In the first relapse, patients are often in good shape to tolerate highly active regimens, which helps in maximizing the impact of the first relapse therapy. The goal is to determine what regimen can be used at a given point that is likely to give the maximum benefit and the least toxicity.

Videos

Shaji K. Kumar, MD, discusses the impact of newer treatment regimens for patients with multiple myeloma and his key takeaways from the current landscape.

New Treatment Regimens Used to Provide Maximum Benefit in Multiple Myeloma

Shaji Kumar, MD, consultant of hematology, Mayo Clinic, discusses the shift in the treatment landscape for patients with multiple myeloma (MM), and how more patients are eligible for stem cell transplantation because of new criteria.

In the setting of newly diagnosed MM, there are many ongoing phase III clinical trials. Several of these studies include patients who are ineligible for stem cell transplantation. In the past melphalan, the backbone therapy for such patients, was used in this setting. A wider understanding of transplant eligibility has changed this. Aside from how old patients are, oncologists now look at factors like frailty and patient choice when deciding whether or not to use a melphalan-based approach.

In the modern landscape, the choice of therapy for newly diagnosed patients with MM is starting to be identical whether these patients are transplant eligible or ineligible. The treatment regimens used in this patient population are typically 3-drug or 4-drug combinations. Studies have found that even older patients can tolerate these same combinations, but they require lower dosages.

Shaji Kumar, MD, discusses the shift in the treatment landscape for patients with multiple myeloma, and how more patients are eligible for stem cell transplantation because of new criteria.

Treatment Strategies for Transplant-Ineligible Patients With Multiple Myeloma

Shaji Kumar, MD, professor of medicine in the Division of Hematology at the Mayo Clinic, discusses the effects genetic abnormalities have on patients with high-risk multiple myeloma. Recent advancements have helped to identify these abnormalities in patients.

The fluorescence in situ hybridization (FISH) test is the most commonly used test to discover changes in both the chromosomal and gene level. Some patients have overlapping abnormalities, such as deletion of chromosome 17p and amplification of 1q. The deletion of 17p has been associated with poor outcomes in both the newly diagnosed and relapse setting.

Certain gene expressions have been associated only in cases of high-risk multiple myeloma. These expressions cannot always be picked up with the FISH test but can be identified in other tests.

Thousands of multiple myeloma samples have been used for sequencing the mutations within these patients, leading to better predictions of outcomes. Mutations are the ultimate driving factor in the outcome of many patients, so having an understanding of these can help in treatment plans down the road.

A Look at Mutations in Patients with High-Risk Multiple Myeloma

Shaji Kumar, MD, professor of medicine, Mayo Clinic, discusses the efficacy seen with venetoclax in multiple myeloma during the ASH Annual Meeting 2016.

Shaji Kumar, MD | Authors

Articles

New Treatment Regimens Used to Provide Maximum Benefit in Multiple Myeloma

Treatment Strategies for Transplant-Ineligible Patients With Multiple Myeloma

A Look at Mutations in Patients with High-Risk Multiple Myeloma

The Efficacy of Venetoclax in Multiple Myeloma