ASH 2020 Updates: Improving Outcomes in TIE-NDMM - Episode 5

Transplant-Ineligible MM: Applying Data into Clinical Practice

Considerations regarding current clinical practice patterns for transplant-ineligible myeloma and the uptake of newer data by health care professionals.

Rafael Fonseca, MD: For patients who are not eligible for transplant, the combination of real-world data plus clinical trials can really guide us into a future where we will have better, safer treatments. In many ways, they will be more personalized as well. One of the boundaries that we haven’t really explored is that with real-world data you can also look at comorbidities. That’s going to be important so that we can better understand what the implications are for those when it comes down to ability to tolerate the complete treatment.

Quality of life of myeloma patients becomes critically important. They’re living for many years. In particular, we have to focus on those toxicities associated with the specific agents we use but also the quality of life associated with the treatments that are being employed, as far them not having to get more treatment. The 2 big ones are the neurocognitive effects of steroids—they pose significant challenges to patients—and peripheral neuropathy.

Peripheral neuropathy is associated with the administration of bortezomib, even though it’s less common when we use a subcutaneous and weekly dose. When it happens it stays, and it has major implications on quality of life. Because of that, and because of the convenience of using it, in my clinical practice I’ve used quite a bit of daratumumab, lenalidomide, and dexamethasone.

ASH [American Society of Hematology Annual Meeting] provided further data and glimpses into an even more hopeful future for both myeloma patients and oncologists. As oncologists, we like to see this because we like to have more options to treat our patients.

We see that the ability to control the disease is getting better. We see further progress in the area of immunotherapy. In 10, or perhaps even 5 years from now, myeloma will be a completely different disease from anything we’re treating at the moment.

Transcript edited for clarity.