Maintenance Therapy after a Transplant for Multiple Myeloma

Summary: Maintenance therapy after a stem cell transplant is used to decrease early death, increase time to progression and improve the quality of life in patients with multiple myeloma. Dr. Callander provides an overview of the history of maintenance therapy and discusses the new and exciting treatment options available. She also delves into potential future therapies that are currently under study.
Presenter: Natalie Callander MD, UW Health Carbone Cancer Center
To read the transcript, go to:
bmtinfonet.org...
Highlights:
(07:16) The goals of maintenance therapy include prolonged control of disease, reduced risk of early death and improved quality of life.
(16:45) Chromosomal abnormalities can be tested using FISH (fluorescent in-situ hybridization) or next-generation sequencing. These genetic mutations in multiple myeloma cells help determine the risk category of your disease.
(19:35) Lenalidomide is the only FDA-approved maintenance therapy. Its side effects include GI problems, infections and secondary cancers. The GI problems can be well managed with low-fat diets and bile salt binders such as Colestipol.
(20:15) Routine Maintenance is associated with increased costs which can be a barrier to care for some patients.
(24:32) Maintenance therapy historically uses one drug at a time. Using multi-agent maintenance therapies may be appropriate for patients with high-risk disease. Studies looking at this are in process.
(28:26) Daratumumab is often used as maintenance therapy. It has minimal gastrointestinal side effects but does have an increased risk of infection and decreased response to vaccines as potential side effects.
(29:20) It has yet to be discovered if maintenance therapy can or should be stopped. Studies are currently underway to answer this question.
(29:45) Minimal residual disease (MRD) testing is now possible in multiple myeloma. If your MRD testing is negative, myeloma stays under control longer than if your minimal residual disease test is positive. This information can help guide maintenance therapy.
(35:46) T-cell redirecting therapy, including bi-specific T-cell engagers (BiTE) and Chimeric Antigen Receptor T-cell therapies (CAR-T) may be included in future multiple myeloma maintenance therapy.
(37:55) Three Bi-specific T-cell antigen engager drugs are available for the treatment of relapsed multiple myeloma. These include Teclistamab, Elranatamab and Talquetamab. They are currently being tested as maintenance.
(39:03) Healthy lifestyle behaviors, including good sleep, healthy diet, adequate vitamin D levels and social engagement can contribute to better responses in patients with multiple myeloma.
April 2024, Part of the Virtual Celebrating a Second Chance at Life Survivorship Symposium 2024
Presentation is 40 minutes long with 19 minutes of Q & A.
Key Points:
Lenalidomide is the only FDA-approved maintenance therapy for multiple myeloma and has been shown to delay the progression of multiple myeloma and improve overall survival of patients. It is important to start maintenance with Lenalidomide within six months after transplant.
Medications such as Daratumumab and Carfilzomib have been studied as maintenance therapy with good results, especially in patients with high-risk disease. Combinations using these and other drugs are being investigated to improve rates minimal residual disease outcomes.
T-cell redirecting therapy, including bi-specific T-cell engagers (BiTE) and Chimeric Antigen Receptor T-cell therapies (CAR-T), may be included in future multiple myeloma maintenance therapy. Studies are currently ongoing.
Meet the speaker:
www.medicine.w...
VISIT US ON SOCIAL MEDIA:
/ bmtinfonet
/ bonemarrowstemcelltran...
/ bmtinfonet
x.com/BMTInfoNet
/ bmt-infonet