Durham Myeloma Rounds Pre & Post Assessment
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Pre-Assessment Responses
A 62-year-old patient with newly diagnosed light-chain (AL) amyloidosis and cardiac stage II disease (Mayo 2004 criteria) is being evaluated for systemic therapy. Their care team reviews results of the final analysis of the phase 3 ANDROMEDA trial presented at the 2024 American Society of Hematology (ASH) conference. Which of the following best describes the survival and organ outcomes associated with daratumumab + bortezomib/cyclophosphamide/dexamethasone (D-VCd) compared to VCd alone in this trial?
Improved overall survival (OS) and major organ deterioration–progression-free survival (MOD-PFS), despite >70% crossover to daratumumab in the control arm.
No significant OS benefit (HR 0.89) but a 56% reduction in MOD-PFS events (hazard ratio [HR] 0.44), primarily driven by renal response rates.
Superior hematologic complete response (HemCR) rates (59.5% vs. 19.2%) but no difference in 5-year OS (68% vs. 65%)
Equivalent MOD-PFS (HR 1.02) and OS (HR 0.95), with shorter time to HemCR in the D-VCd arm
2. What is the most significant barrier to expanding BsAbs into the community?
Inexperience among community oncologists to monitor and manage CRS/ICANS
Limited patient demand for BsAb in community setting
Absence of treatment guidelines for BsAb use outside of academic centers
Requirement for inpatient hospitalization for all BsAb SUD administration
3. Which of the following is not considered a way to define high risk smoldering myeloma?
M-protein greater than 2 g/dL, involved:univolved FLC ratio >20, and greater than 20% clonal bone marrow plasma cells
M-protein ≥3 g/dL, BMPCs ≥10%, and the ratio of serum free light chain (sFLC) ≥8 or <0.125
Presence of ≥95% clonal plasma cells among all BMPCs by immunophenotyping and the presence of immunoparesis
All are ways to define high risk smoldering myelom
4. Which of the following treatment options have been FDA-approved for treatment of high-risk smoldering myeloma?
There are no FDA-approved treatments for HRSMM
Daratumumab
Lenalidomide with dexamethasone
Teclistamab
5. 67 yo F with a history of HFrEF with EF of 30% presents for a discussion of maintenance on day +100 post ASCT for multiple myeloma. She was initially diagnosed with back pain with PET revealing multiple bone lesions. Marrow showed 40% involvement. FISH was positive for del 17p on 30% of cells and del1p. After 4 cycles of D-RVd, patient went to ASCT with mel 200. She is MRD (-) after transplant. ECOG is 1 but her QOL has been limited by G2 neuropathy. Which regimen would you most likely recommend?
Lenalidomide monotherapy
Carfilzomib and lenalidomide
Bortezomib and lenalidomide
Daratumumab and lenalidomide
Ixazomib and lenalidomide
Next
Post-Assessment Responses
A 62-year-old patient with newly diagnosed light-chain (AL) amyloidosis and cardiac stage II disease (Mayo 2004 criteria) is being evaluated for systemic therapy. Their care team reviews results of the final analysis of the phase 3 ANDROMEDA trial presented at the 2024 American Society of Hematology (ASH) conference. Which of the following best describes the survival and organ outcomes associated with daratumumab + bortezomib/cyclophosphamide/dexamethasone (D-VCd) compared to VCd alone in this trial?
Improved overall survival (OS) and major organ deterioration–progression-free survival (MOD-PFS), despite >70% crossover to daratumumab in the control arm.
No significant OS benefit (HR 0.89) but a 56% reduction in MOD-PFS events (hazard ratio [HR] 0.44), primarily driven by renal response rates
Superior hematologic complete response (HemCR) rates (59.5% vs. 19.2%) but no difference in 5-year OS (68% vs. 65%)
Equivalent MOD-PFS (HR 1.02) and OS (HR 0.95), with shorter time to HemCR in the D-VCd arm
What is the most significant barrier to expanding BsAbs into the community?
Inexperience among community oncologists to monitor and manage CRS/ICANS
Limited patient demand for BsAb in community setting
Absence of treatment guidelines for BsAb use outside of academic centers
Requirement for inpatient hospitalization for all BsAb SUD administration
Which of the following is not considered a way to define high risk smoldering myeloma?
M-protein greater than 2 g/dL, involved:univolved FLC ratio >20, and greater than 20% clonal bone marrow plasma cells
M-protein ≥3 g/dL, BMPCs ≥10%, and the ratio of serum free light chain (sFLC) ≥8 or <0.125
Presence of ≥95% clonal plasma cells among all BMPCs by immunophenotyping and the presence of immunoparesis
All are ways to define high risk smoldering myeloma
Which of the following treatment options have been FDA-approved for treatment of high-risk smoldering myeloma?
There are no FDA-approved treatments for HRSM
Daratumumab
Lenalidomide with dexamethasone
Teclistamab
67 yo F with a history of HFrEF with EF of 30% presents for a discussion of maintenance on day +100 post ASCT for multiple myeloma. She was initially diagnosed with back pain with PET revealing multiple bone lesions. Marrow showed 40% involvement. FISH was positive for del 17p on 30% of cells and del1p. After 4 cycles of D-RVd, patient went to ASCT with mel 200. She is MRD (-) after transplant. ECOG is 1 but her QOL has been limited by G2 neuropathy. Which regimen would you most likely recommend?
Lenalidomide monotherapy
Carfilzomib and lenalidomide
Bortezomib and lenalidomide
Daratumumab and lenalidomide
Ixazomib and lenalidomide
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