Episode 55. ASH 2024 Myeloma Updates with Dr. Rakesh Popat

37 snips

Jan 11, 2025

Dr. Rakesh Popat, a consultant hematologist and associate professor at UCL, shares insights from ASH 2024 on myeloma and amyloidosis. He discusses the AQUILA trial, highlighting daratumumab's benefits for high-risk smoldering multiple myeloma. The conversation also covers the promising early data of Anito-Cel, a novel CAR T therapy, and updates on survival outcomes for cilta-cel in relapsed myeloma. Additionally, he reviews long-term advancements in treatment strategies for AL amyloidosis and ultra-high-risk myeloma patients.

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INSIGHT

Daratumumab for High-Risk Smoldering Myeloma

Daratumumab significantly reduces progression risk in high-risk smoldering myeloma.
This is relevant despite the trial using older criteria, as shown by additional analysis with updated criteria.

ADVICE

Surveillance for Smoldering Myeloma

Use whole-body diffusion-weighted MRI for active surveillance in high-risk smoldering myeloma.
Dr. Kaiser has done a lot of work on this approach.

INSIGHT

Mode of Progression in Smoldering Myeloma

Most progressions in the control arm were not morbid (e.g., fractures or renal failure).
This is reassuring for patients who don't want treatment, provided they're closely monitored.

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In this episode, we dive into the hottest updates in myeloma and amyloidosis at ASH 2024 annual meeting with Dr. Rakesh Popat. Here are the abstracts we discussed:

1. AQUILA Trial in High-Risk SMM

Overview of the AQUILA trial testing single-agent daratumumab for high-risk smoldering multiple myeloma (HR-SMM) versus active monitoring.
Discussion on patient characteristics, primary endpoints, and results showing significant progression-free survival (PFS) benefit with Dara.
Insights into modes of progression, adequacy of active surveillance, and post-protocol therapy in control arm.
Read the abstract.
Read the simultaneous publication at NEJM.

2. Anito-Cel: New BCMA CAR T Therapy

Early data from the iMMagine-1 trial showing strong efficacy and a promising safety profile for Anito-Cel, a novel BCMA CAR T.
Discussion of its potential to rival cilta-cel while avoiding neurotoxicity concerns.
Read the abstract.

3. CARTITUDE-4 Update

Updates on MRD-negativity rates and survival outcomes for cilta-cel in relapsed myeloma, with significant benefits over standard care.
Read the abstract.

4. ANDROMEDA OS Data in AL Amyloidosis

Long-term data showing an overall survival (OS) benefit of Dara-VCd over VCd in AL amyloidosis.
Insights into cardiac responses and crossover impact.
Read the abstract.

5. OPTIMUM Trial in Ultra-High-Risk NDMM

Five-year follow-up of a tailored approach for ultra-high-risk newly diagnosed myeloma patients with continuous therapy incorporating multiple active agents.
Subgroup outcomes highlighting both challenges and exceptional results.
Read the abstract

6. GMMG-HD7 Trial PFS Update

Phase 3 trial results on Isa-VRD vs. VRD induction and risk-adapted tandem ASCT.
Discussion on the role of CD38 in maintenance therapy.
Read the abstract
Read the simultaneous publication at JCO

7. Exciting New Drugs

Review of three innovative therapies: inobrodib, a BCMA-CD38 trispecific antibody, and cevostamab, a FcRH5-targeted bispecific antibody.
Expert insights into their efficacy and potential to reshape myeloma care.
Read the abstract