ASH 2020 Updates: Improving Outcomes in TIE-NDMM - Episode 1

New Therapies for Transplant-Ineligible Myeloma

Mayo Clinic’s Rafael Fonseca, MD, comments on the benefits of newer therapies that are now available for patients with newly diagnosed transplant-ineligible multiple myeloma.

Rafael Fonseca, MD: As we saw during the recent ASH [American Society of Hematology Annual Meeting], we have a number of new treatment options available for patients who are transplant ineligible. This builds from a legacy of studies that have been presented over the past 3 to 4 years. Nowadays, the majority of patients who are over the age of 75 are steered away from stem cell transplant. There is no doubt that there’s an increased toxicity in this patient population. Fortunately, some of the combinations are highly active and have been proven through various phase 3 clinical trials to be able to prolong the period of disease control for patients with advanced disease. Notably, we have data from the ALCYONE clinical trial, the MAIA study, and a recent SWOG trial.

One might even start to wonder if there are different ways we could measure longevity for those who are transplant ineligible, because many of those patients will have such a prolonged period of disease control and survival. For patients who are of advanced age and are diagnosed with multiple myeloma, assuming they tolerate their treatment, oftentimes their survival will be similar to what’s expected in the general population. So it’s not the PFS [progression-free survival], but it might be the delta between life expectancy for that person and what they can see with the best myeloma therapy.

The recent FDA approval for daratumumab has essentially been a game changer in treating multiple myeloma for multiple reasons. No. 1 is the convenience of the administration. This greatly reduces the time that a patient has to be at the treatment center and allows patients who have limited mobility or difficulty with transportation to receive treatment more efficiently. Treatment centers are able to treat more patients in a more expedient fashion. That’s No. 1. Second, of course, we see a decreased number of infusion-related reactions when patients are treated this way.

Since the medication was approved by the FDA, I have completely changed my practice to totally administering subcutaneous daratumumab for new patients as well patients who are switching back from the infusion form of the medication. That’s what we are doing, and I will continue to do that. I can tell you, patients are delighted with this approach because of the factors I just mentioned.

Transcript edited for clarity.