A 75-Year-Old Woman With Multiple Myeloma - Episode 6

Current and Future Treatment Options for Multiple Myeloma Patients

Saad Usmani, MD, speculates on the current progress in treating multiple myeloma, while providing a glimpse into the future of cutting-edge treatments.

Saad Usmani, MD: The biggest impact we’ve made in patients with myeloma is for standard and intermediate-risk patients. The triplet-induction approach followed by consideration of stem cell transplantation, followed by maintenance, has become a standard of care for patients with myeloma. Now we’re thinking about quadruplet therapies for those patients to try to get deeper responses during that first year of diagnosis.

The challenge for us is in high-risk myeloma. Because myeloma is a heterogenous disease, we see high risk both with clinical features as well as specific biologic features on FISH [fluorescence in situ hybridization] cytogenetic.

There are a lot of newer drugs, newer platforms like bispecific antibodies, antibody-drug conjugates, and chimeric antigen receptors T-cell and anti–T-cell therapies that are coming down the line. For our colleagues practicing in the communities, it is important to partner with your closest myeloma center to give your patients access to those kinds of therapies. I suspect that over the next 5 years, navigating the various options of treatment are going to be a big challenge. People like me are still trying to figure it out, and it’s going to be more challenging for our community colleagues. Strengthening that partnership is going to be important so we can deliver the best possible care for our patients with myeloma.

Transcript edited for clarity.


Case: A 75-Year-Old Woman With Multiple Myeloma

Initial Presentation

  • An active 75-year-old woman presented with new onset back pain and a 10-month history of fatigue, mild sensory neuropathy
  • PMH: hypercholesterolemia, diabetes, and atrial fibrillation; all medically controlled
  • PE: bony tenderness appreciated on the hips and lower back


Clinical Workup

  • Labs: Hb 10.2 g/dL, calcium 11.1 mg/dL, LDH 186 U/L, creatinine 1.3 mg/dL, albumin 3.7 g/dL, beta-2 microgloblulin 3.6 mcg/mL, potassium 1100 g/dL, M-protein 2.6 g/dL, lambda free light chains 4.1 mg/dL
  • Hepatitis B and C negative
  • X-ray showed L4 vertebral compression fracture
  • Skeletal survey showed multiple lytic lesions in femur
  • Bone marrow shows 40% clonal plasma cells IgG k with hyperdiploidy FISH
  • Diagnosis: R-ISS stage II MM
  • ECOG 1

Treatment

  • Patient is ineligible for ASCT due to comorbidities
  • Initiated treatment with daratumumab + lenalidomide + dexamethasone