Multiple Myeloma: Stem Cell Transplant and Beyond 2021

Summary: Learn when patients with myeloma should consider transplant, steps involved in transplant, maintenance therapy options after transplant, and new therapies to manage multiple myeloma. Multiple myeloma is the most common cancer of the bone marrow. This presentation discusses transplant options and drug therapies for treating myeloma. It also reviews options for maintenance therapy and responding to relapses.

Presenter: Frits van Rhee MD, PhD, Professor of Medicine and Clinical Director of the UAMS Myeloma Center, University of Arkansas for Medical Sciences. Meet Dr. Rhee: https://uamshealth.com/provider/frits...

To read the transcript, go to: https://www.bmtinfonet.org/video/mult...

Highlights:

- Early aggressive treatment is indicated for multiple myeloma because the second remission is usually shorter than the first one. For transplant eligible patients, autologous transplant remains the frontline therapy.
- Maintenance therapy is better called extended therapy because it is used not only to maintain remission and prevent relapse but also to eradicate residual myeloma cells. However, balancing its benefits versus its toxicity makes for a challenging decision about when to stop maintenance therapy.
- CAR-T cell therapy shows promise for treating multiple myeloma despite significant side-effects. Transplantation remains the standard treatment although with improvement in the efficacy and tolerability CAR-T cell therapy, it may partially replace transplantation in the future.

Presented at the 2021 Celebrating Life a Second Chance at Life Virtual Symposium, April 17-23, 2021.
Presentation is 38 minutes long with 21 minutes of Q & A.

Key Points:

(03:57) Myeloma involves malignant cells that infiltrate bone marrow and crowd out normal cells. It can cause anemia as well as bone destruction.

(06:53) Physiological age is more important than chronological age in transplant eligibility. Older but fitter patients may be better candidates than younger but sicker individuals.

(08:00) The aggressiveness of the disease also informs decisions about transplantation by dividing patients into high risk or standard risk groups.

(10:39) Transplant involves harvesting the patient’s own cells and returning them after high-dose chemotherapy. Additional cells may be harvested for a second or even third transplant if needed.

(13:11) Survival outcomes are better with transplant than with novel drug therapies alone.

(14:58) Using medications like daratumumab may improve the response rate and overall outcome.

(19:29) There are several options for maintenance therapy. These include Revlimid, proteasome inhibitors, and combinations of various drugs.

(21:35) Relapses can occur sooner or later and slower or faster. Treatment for relapse is highly individualized based on previous toxicity, blood counts, and marrow reserve.

(23:58) Several drugs are available for relapsed myeloma. Their side effects should be closely monitored.

(36:50) Newer therapies are mostly used for relapse, although clinical trials are underway to assess their efficacy for use in earlier treatment and for highly aggressive disease.

Meet the speaker: https://uamshealth.com/provider/frits...

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