Regarding sequencing of CAR T: Prior High-dose melphalan (HDM) and stem cell transplant was associated with lower progression-free survival (PFS), but it does not seem to impact overall survival (OS). A question from Dr. Banerjee (MM celebrity), ”Would collecting stem cells and T-cells before transplant fix this problem?”
Hopefully, a study will be conducted to address this.
One of the big new studies by Dr. Banerjee was looking to see if our least favorite lab test, the twenty-four-hour urine, is still needed in light of better testing. The answer is NO! (with several caveats). It is still needed at initial diagnosis or if Bence-Jones proteinuria is the only marker of disease. The hope is that this new recommendation will be adopted by IMWG in the near future. I plan to make this a non-negotiable plan with my doctor starting now!
A special kind of session has been added to ASH, the Health Equity Studio Program, to address Diversity, Equity and Inclusion (DEI) in the healthcare field. The presenter talked about the very complicated issues for undocumented immigrants and mixed-status families. I’m proud to live in a state (MN) that has passed a law allowing undocumented immigrants to enroll in MinnesotaCare. Some states deport ill patients to other countries where they may not get the care they need. Philadelphia has outlawed this practice, showing that change can happen on the local level.
For newly diagnosed patients there are many choices and many questions. Dr. Shaji Kumar says that while four drugs (quads) show improved PFS, a patient’s frailty and tolerance may affect the choice. Drug maintenance with Revlimid (lenalidomide) and dexamethasone (len/Dex) is recommended, yet it is better if both drugs’ doses are reduced.
A presentation about transplantation says that it’s still preferable to chemo alone. I can’t help but wonder when it will be phased out in preference for BsAbs and CAR T.
We all know what MGUS is, but I learned about 2 new ones, MGCS and MGRS, clinical significance, and renal significance.