How to select maintenance therapies post-ASCT for patients with high-risk MM?
Sep 18, 2023
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Experts Shaji Kumar and Naresh Bumma discuss selecting maintenance therapies post-ASCT for high-risk MM. They debate lenalidomide monotherapy vs. combination therapy with a proteosome inhibitor, the challenges of defining high-risk populations, and the need for prospective trials. Kumar and Bumma share their management strategies and highlight the future of managing high-risk MM post-ASCT.
Defining high-risk MM challenges include varied cytogenetic definitions, like 17p deletions and translocations, prompting a need for consensus statements.
The benefits of combination maintenance therapies, including bortezomib and lenalidomide, are crucial for achieving deeper responses in high-risk MM patients post-ASCT.
Deep dives
Challenges in Defining High-Risk Patients
Defining high-risk multiple myeloma patients presents challenges due to varying definitions of high-risk cytogenetics, including factors like 17p deletions, translocation 4;14, translocation 14;16, and gain 1q. Ambiguities exist in classifying 1q gain and amplification. Discussions are ongoing to establish consensus statements to bring clarity and consistency to clinical trials.
Maintenance Therapy for High-Risk Patients
The podcast explores the complexities of maintenance therapy for high-risk multiple myeloma patients. It discusses the use of bortezomib and lenalidomide in maintenance, highlighting retrospective data comparisons and the potential benefits of combination therapies like bortezomib and lenalidomide or anti-CD38 drugs. The importance of achieving deeper responses through maintenance therapy is emphasized.
Future Research and Considerations in Treatment
The conversation delves into the need for prospective trials in post-transplant therapy for multiple myeloma. It addresses evolving treatment approaches, such as incorporating bi-specific antibodies pre-transplant and evaluating the impact of maintenance therapy duration based on pre-treatment responses. The discussion also touches on the role of CAR-T versus stem cell transplant and the importance of inclusive trial designs for various patient populations, including those with renal failure or extra-medullary disease.
The Multiple Myeloma Hub was pleased to speak to Shaji Kumar, Mayo Clinic, Rochester, US, and Naresh Bumma, The Ohio State University, Columbus, US. We asked, How to select maintenance therapies post-autologous stem cell transplant (ASCT) for patients with high-risk MM?
In this expert discussion, Shaji Kumar and Naresh Bumma provide their insights into post-ASCT maintenance therapy for high-risk patients. The experts consider the use of lenalidomide as a monotherapy versus in combination with a proteosome inhibitor, whilst sharing their thoughts on the challenges in defining the high-risk population.
Kumar and Bumma present their individual management strategies for this patient population and examine existing clinical data, highlighting the need for prospective trials. This discussion concludes with a look to the future management of high-risk multiple myeloma post-ASCT.