Key Clinical Insights for the Management of Newly Diagnosed Multiple Myeloma

EP: 1.Patient Profile: A 54-Year-Old Woman with Newly Diagnosed Multiple Myeloma

EP: 2.Overview of Results from the DETERMINATION Trial of RVd plus ASCT for Newly Diagnosed Multiple Myeloma

EP: 3.Discussion of Final Analysis of the GRIFFIN Study Comparing DARA+RVd versus RVd

EP: 4.Review of Primary Outcomes from the PERSEUS Trial of Subcutaneous DARA+VRd in Transplant-Eligible Newly Diagnosed Multiple Myeloma

EP: 5.Overview of the IsKia Trial Results Evaluating Isatuximab + KRd in Transplant-Eligible Newly Diagnosed Multiple Myeloma

EP: 6.Summary of Final Analysis from the MASTER Trial of DARA+KRd

EP: 7.Discussion of Phase 2 IFM 2018-04 Study Data Presented at 2023 ASH Examining DARA+VTd with Tandem ASCT for High Risk Transplant-Eligible Newly Diagnosed Multiple Myeloma

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EP: 8.Key Clinical Insights for the Management of Newly Diagnosed Multiple Myeloma

Case: A 54-Year-Old Woman with Newly Diagnosed Multiple Myeloma (NDMM)

Clinical Presentation:

• FH is a 54-year-old woman who presents to her physician with complaints of back pain, fatigue, nausea, constipation, and occasional, but recurring dizziness

Initial Clinical Workup and Diagnosis:

• Hb 7.0 g/dL
• Calcium 11.3 mg/dL
• Creatinine, 1.5 mg/dL
• Albumin, 3.2 g/dL
• β2-microglobulin, 6.0 mg/dL
• LDH 200 U/L
• Bone marrow biopsy showed monoclonal plasma cells, 22%.
• Serum monoclonal protein, 5.0 g/dL
• Serum kappa FLC, 240.0 mg/L
• FISH: (+) IGH Translocations; none
• ECOG PS 1
• AG was diagnosed with R-ISS stage II/R2-ISS stage III IgG-kappa myeloma.
  • CAR T eligible

Treatment:

• Patient was initiated on daratumumab/bortezomib/ lenalidomide/ dexamethasone (D-VRd) induction therapy prior to receiving ASCT, followed by lenalidomide maintenance therapy.
  • She achieved VGPR post-induction, and
  • Maintained VGPR post-ASCT

This is a video synopsis/summary of a Case-Based Peer Perspective featuring: Douglas Sborov, MD.

When it comes to newly diagnosed transplant-eligible multiple myeloma, the standard of care is now quadruplet induction. All patients should undergo stem cell collection and have a discussion regarding the potential utility of transplant. High-risk patients should receive doublet maintenance therapy following transplant. Relatively early discontinuation or dose reduction of steroids should be considered as they are not necessary long term, including in the maintenance setting. Risk stratification for clotting should occur at diagnosis, and most patients will require direct oral anticoagulant prophylaxis rather than aspirin alone to mitigate immunomodulatory drug-associated clot risk. Lastly, given the emergence of exciting novel therapies like chimeric antigen receptor T-cell and bispecific antibodies, coordination of care with an academic myeloma program should always be considered.

Video synopsis is AI-generated and reviewed by Targeted Oncology® editorial staff.