Expert Perspectives on a 75-Year-Old Woman With Triple-Class Refractory Multiple Myeloma - Episode 2
An expert in multiple myeloma provides insight on the treatment challenges for patients with triple-class refractory disease, particularly after fourth or later lines.
Adriana Rossi, MD: Reviewing all of the findings for this case, I think a few important things show up. This patient has now been exposed to IMiDs [immunomodulatory drugs], proteasome inhibitors, and an anti-CD38 antibody, and is what is now called a patient with triple-class refractory multiple myeloma. It’s not an uncommon case, especially in the academic world where I am at a tertiary referral center. Many patients who come to me are exactly those patients who have had all of the easily accessible frontline medications and are now running out of standard options. I think it’s interesting to try to look at prognosis. We really don’t know at this point. The field is moving so fast; there are so many new agents coming up that are changing the landscape and changing the field. Last time we looked, I think back in 2017, and had data on proteasome inhibitor- and IMiD-refractory patients, we were expecting them to have an overall prognosis of about a year. But we now have a number of studies in these multiply refractory patients where we are getting deep and meaningful responses, not only CRs [complete responses], but MRD [minimal residual disease] negativity in the relapsed setting. I think that will absolutely translate to a survival difference. So we need more time to be able to see the effect this will have.
But it is challenging. This patient comes in with a significant clinical relapse. We often would monitor patients every month. Part of that is to not give time for the myeloma to get so unruly. If you are monitoring every month and you see signs of a biochemical relapse, where the M spike is going up but the end organ damage is not there, it gives you time to think and pick drugs, and hopefully prevent the damage. In this case, her anemia is quite severe, her renal function is impaired, and she has extensive bony disease. Part of what’s not addressed in the case is whether she has any antiresorptive therapy as part of her treatment plan. I would say any patient, not only those with lytic lesions, but all patients with myeloma, should have their chemotherapy complemented with either zoledronic acid or denosumab.
Transcript edited for clarity.
Case: A 75-Year-Old Woman with Triple-Class Refractory Multiple Myeloma