In separate live, virtual events, David Dingli, MD, PhD, and Douglas W. Sborov, MD, MS, discussed with participants how they would treat a patient with multiple myeloma in accordance with the available therapeutic regimens.
A 54-year-old woman presented with Revised International Staging System stage II multiple myeloma, based on evaluations that showed a hemoglobin level of 7.0 g/dL, β2-microglobulin of 6 mg/dL, albumin of 3.2 g/dL, calcium of 11.3 mg/dL, lactate dehydrogenase of 200 U/L, and creatinine clearance of 45 mL/min. Bone marrow showed 22% clonal plasma cells. Serum κ free light chains were 24 mg/dL. She had an ECOG performance score of 1 and no cytogenetic abnormalities. A PET/CT scan showed multiple bone lesions in the vertebrae. She had no extramedullary disease. She was diagnosed with IgGκ myeloma and was considered transplant eligible.
SBOROV: The interesting thing about the polling question here of the quadruplet vs the triplet is it’s very much a debated topic in the newly diagnosed myeloma space right now….We have the newly diagnosed transplant [eligibility] guidelines [from the National Comprehensive Cancer Network (NCCN)].1 VRd [bortezomib (Velcade)/lenalidomide (Revlimid)/dexamethasone] is a preferred regimen; we also include KRd in this [carfilzomib (Kyprolis)/lenalidomide/dexamethasone]. Daratumumab-VRd [is under “other recommended regimens”]….I do want to highlight that we also include Dara-KRd as useful in certain circumstances. If you ever want to move in that direction, you do have the NCCN guidelines to back you up for that quadruplet.
DINGLI: I believe that achieving a deep response in multiple myeloma is very important. The best chance to control the disease and have the longest impact on patients is first-line therapy. If we look at any trial, the longest [progression-free survival] is with first-line therapy. Currently, a patient with newly diagnosed myeloma will be expected to live 8 to 10 years. Half of that or more is based on induction therapy, transplant, and maintenance. A [patient who is] standard risk now is expected to have a response to transplant that could last 50 or 60 months. Well, that’s more than half of their expected survival, assuming there are no developments, which is not [always] the case. But my point is that early decisions are going to have a major impact on the long-term outcome for these patients.
1. NCCN. Clinical Practice Guidelines in Oncology. Multiple myeloma; version 3.2023. Accessed January 11, 2023. https://bit.ly/2T0mDYS