Dec 17, 2024 | Sheri Baker
What another great experience for myself and our Myeloma Voices Team at ASH (American Society of Hematology). San Diego is such a nice place to visit, and I really enjoyed being with our in-person team as we attended the sessions together, discussed what we had heard, and dined together. We all come from slightly different backgrounds and myeloma journeys, but we all have one thing in common: The hope of finding a cure for multiple myeloma (MM).
There were a variety of abstracts that caught my eye. The first one was Saturday morning with the study that showed previous treatment with high-dose melphalan (HDM) and an autologous stem cell transplant (ASCT) adversely impacts progression-free survival (PFS) in BCMA-directed CAR-T therapy. Their findings showed that having a prior HDM/ASCT is associated with a shorter PFS to a BCMA CAR-T, but it did not impact the response rate or overall survival (OS). Which CAR-T product you received made a difference.
Ide-cel (Abecma) showed a lower complete response (CR) and a shorter PFS. But, there was no difference between the 2 groups (ASCT or no ASCT) with Cilta-cel (Carvykti) or Anito-cel (still in clinical trials). Will these findings make a difference in the future of ASCT or help to decide which CAR-T therapy is best for which patient? Further clinical trials of CAR-T therapy for newly diagnosed multiple myeloma (NDMM) patients could provide further insights into this question.
The next abstract presented by Dr. Rahul Banerjee (Fred Hutchison Cancer Center), stated that the infamous twenty-four-hour urine testing does not add value to the assessments of MM patients. Real-world analysis showed that only 28% of U.S. patients with MM had any twenty-four-hour urine testing done at diagnosis. In his study, only 1.1% of the analyzed patients had different responses between traditional and urine-free response criteria. The 24-hour urine testing is still essential in screening patients with MGRS (monoclonal gammopathy of renal significance), for example, having AL amyloidosis. But Dr. Banerjee is hoping to have the International Myeloma Working Group (IMWG) place less emphasis on the twenty-four-hour urine requirements in future revised response criteria.
An interesting study was presented by Dr. Craig Hofmeister with the Winship Cancer Institute of Emory University in Atlanta, GA. He presented a trial that demonstrated a three-dose flu vaccine series improves protection over a single flu shot. This was especially true for patients, like myself, who are on Darzalex (daratumamab). The study showed that a single flu vaccine’s seroprotection wanes by the end of the flu season. Giving the vaccine at week 1, week 9, and week 17 improves protection, especially for patients on daratumamab.
Of course, there are obstacles to this in the real-world. It can be hard to convince patients to get 1 flu vaccine, much less 3 over the flu season. And getting insurance to pay for 3 would be difficult, as would asking patients to pay out-of-pocket for 2 of the 3 vaccines. It is still an interesting study, given the older population of myeloma patients, and the propensity for serious illness from getting the flu.
Every year at ASH my takeaway is how many patients are participating in clinical trials around the world. If it were not for these patients, we would not have new myeloma treatments. At the end of every abstract presented, the doctor thanked the patients and their families for participating. I have not been able to participate in a trial yet, but it is my hope that I may be able to give back and participate one day. There is so much more, and I hope you read the blogs of my fellow Myeloma Voices Team. And join us on January 8th as we discuss the latest myeloma updates from ASH 2024.
-Sheri
@blondie1746 on X(Twitter)
Dec 15, 2024 | Linda Huguelet
This year’s American Society of Hematology (ASH) Annual Meeting was filled with fascinating new treatments and treatment combinations which left me thinking that there is so much more information to digest as a patient than when I was diagnosed in 2010. Over my 14 years as a myeloma patient, I’ve been through 5 lines of therapy. In conjunction with my specialists and local hematologist, I’ve made treatment decisions over the years at each relapse. I used the available information to help me have a candid discussion with my physicians before coming to a decision. Several of the options seemed fairly obvious at the time, given the more limited number of choices.
In 2010, there was no question that Revlimid (lenalidomide), Velcade (bortezomib), and dexamethasone was the way to go for upfront treatment. It was somewhat comforting that there wasn’t a need to decide on a treatment plan on day 1 when your head was still spinning from the fact you had cancer and all the new terminology. If you were transplant-eligible, it was basically assumed you would do this following your upfront cycles.
In 2024, the standard of care for a newly diagnosed patient is a combination of 4 medications which includes the addition of a monoclonal antibody – Darzalex (daratumumab) or Sarclisa (isatuximab). Which is best for each individual patient? These combinations have proven to produce very deep responses in most, so is there a need for a transplant upfront or ever? Some physicians still favor transplant, some say save it for relapse, and some aren’t convinced the exposure to the high dose chemotherapy is necessary.
At this year’s ASH, TECVAYLI (teclistamab) was presented in several abstracts as a possible future option in upfront and maintenance therapy. This drug is currently only used after multiple lines of therapy. If the trials prove this out and it gets approved by the Federal Drug Administration (FDA), this adds yet another layer of complexity to the treatment sequencing puzzle. The passion the researchers display at ASH is comforting because they are doing everything they can to provide more and better options for myeloma patients. On the flip side, this makes the need to have a myeloma specialist on your team essential to help understand the options and help you evaluate the options.
At my first Support Group Leader Summit in 2011, I vividly remember Susie Durie standing before the group and exclaiming that knowledge is power! She encouraged us to be as informed as possible and be an advocate for ourselves during your entire myeloma journey and to encourage our support group members to do the same. Those words could not ring truer today. Thanks to the International Myeloma Foundation (IMF), we have the tools to be informed. Take advantage of reading the blogs from all participants in this year’s meeting because each provides information for you to consider, call the InfoLine, ask Myelo questions on the IMF website, register for the December 18th webinar (IMWG Conference Series – Making Sense of Treatment) — do whatever works best for you to stay informed and on top of the latest developments. This will help you put all the myeloma pieces of the puzzle together more easily!
Linda Huguelet, Chattanooga Multiple Myeloma Networking Group
@LindaMYELOMA
Dec 12, 2024 | Terry Glassman
I am traveling today and then a very busy treatment day, so I’m going to do a quick post-ASH blog. Yet, if you want to hear more in-depth, check back because I promise another blog within a week.
First off, one of my fellow patients who follows me asked, “it must be hard listening to all this information.” Honestly, it was not; it was encouraging and hopeful. As I’ve mentioned before, my Myeloma Specialist told me on my first visit; “The longer I keep you alive, the longer I can keep you alive.” That sentiment stayed with me throughout ASH. It was palpable as I listened to the latest research and advances in treatment…hopeful progress everywhere!
It was heartening to see how dedicated these physicians and scientists are. So many brilliant minds sharing, questioning, and learning from each other! Sure, at times I felt like they were talking about me and us, but I’ve long come to terms with the reality of living with a serious disease. I follow that up with: I have these incredibly serious people working on controlling, and ultimately, curing it! That gives me hope, and that’s what keeps me going.
I’d also like to reiterate another mantra of mine here; see a Multiple Myeloma (MM) Specialist—it really matters!
Okay, Days 2 & 3 Quick Synopsis
Dara, Dara, Dara, Isa!
It is a big deal when a treatment changes the standard of care, and the anti-CD38 antibodies have done just that! Quadruplet therapy as a standard of care in induction therapy has shown amazing results! Even more exciting? Darzalex (daratumumab) has also been shown to prolong progression-free survival (PFS) when used in maintenance therapy. But…wait…there’s more!
Dara is showing incredible promise in high-risk smoldering multiple myeloma (HR SMM). And although Dara took up a lot of space, Sarclisa (isatuximab) showed promising results in induction therapy as well! Isa “might” change the microenvironment, which “might” slow down the rate of progression. It will be interesting to see if this theory plays out and how it plays out!
Next up: Bispecific Antibodies!
Tecvayli (teclistamab) took the center stage in a phase two study, showing promise in induction therapy as both a safe and highly effective treatment. On to phase 3, but it looks very promising. All evaluable patients achieved Minimal Residual Disease (MRD) negativity during maintenance. Patient note: Here’s where the hope keeps sneaking back in!!
Teclistamab is also being looked at in maintenance therapy and early results are positive as well as relapsed/refractory multiple myeloma (RRMM). Elrexfio (elranatamab), Kyprolis (carfilzomib) with dexamethasone are being studied as well.
SO much in the pipeline for Bispecific Antibodies! AND…as if that weren’t enough a bispecific antibody with a new target, Cevostamab is being studied in a phase one clinical trial in heavily pretreated patients and has shown meaningful activity and manageable safety in this patient population at the 160mg TD level given once every 3 weeks.
Studies with Talvey (talquetamab) and Blenrep (belantamab mafodotin) are also showing promise. Though they are sometimes considered harder to tolerate due to the negative side effects, there’s good news here: With adjustments in timing and dosage, these treatments are still effective in managing disease while keeping side effects under control.
New on the scene is Etentamig (also known as ABBV-383), a monthly dosed bispecific antibody. Early studies are promising, and it’s definitely one to watch. I personally was intrigued by its binding domain and its potential to mitigate cytokine release syndrome (CRS) More to come!
Smoldering Multiple Myeloma (SMM): New Hope on the Horizon
When a person has smoldering multiple myeloma and their myeloma is growing, doctors often consider this a “watch and wait” situation. This can be stressful and anxiety-inducing for patients, but the AQUILA study offers hope. It shows that treatment with Dara can extend time before active treatment is required in the high-risk SMM population.
Frailty
Research was presented that looked into the following: reduced dosing, decreased dexamethasone, and clinical trials including older patients. More to come on that, but I will say Darzalex (daratumumab), Revlimid (lenalidomide), or DR outperformed Revilimid (Lenalidomide) and dexamethasone (Rd) in the frail population…down with Dex!!
I’ll stop here for now with the promise to return and further clarify. I hope to share more information once I stop long enough to look at my notes and absorb the immense amount of information I took in over the past three to four days! This is by NO MEANS a comprehensive review; it’s just what caught my attention. Again, I remind all who are reading, this is the takeaway from me…a humble fellow MM patient, and it is how I personally understood the information presented! I hope it gives you a good starting point to delve deeper into the information yourself and discuss what you find with your care team.
It’s exciting to see all this research across the spectrum of treatment lines. It is a non-ending quest for better, safer, and more effective treatment of MM. I was humbled and honored to be a part of the IMF team, and this nerd can’t wait to look at a few of the presentations I did not get to attend! I did have a focus on High-Risk Multiple Myeloma (HRMM), but I did not find much discussion on this. Yet, many studies did include high-risk patients. I will delve deeper in the coming days and share what I find.
That’s it for now! I’ll be back soon with a more detailed post on what I’ve learned from ASH. Thanks for following along and remember: There is always hope! Stay strong, keep fighting, and always reach out to your specialist and team with any questions you may have! They are working every day for us!
HOPE
Hardworking MM specialists and oncologists.
Optimism SO much research for newly diagnosed and those exposed to many lines.
Patients…the center of it all!
Energy! That is what I saw most at ASH an uncontainable energy to do more, know more, help more!
Dec 8, 2024 | Terry Glassman
We started our day at 5:30 am by hopping on a shuttle to head over to the International Myeloma Working Group Breakfast sponsored by the IMF. I must say it was an extraordinary experience to be in the room with all the top Myeloma Doctors, listening to their research (which I can’t tell you about or I’d have to kill you…not really, that’s from a movie…but I can’t tell you)! What I can tell you is that this is a VERY dedicated group of physicians, and they are working hard to advance treatment in multiple myeloma (MM) for us all. We are in VERY GOOD hands! I’ve listened to so many of these specialists in webinars that I felt like I knew them! I had to remind myself that I indeed did not know them, but I thanked whomever I did talk to for the work they do! Some pretty exciting stuff in the pipeline: some of it will be reported on in the coming days, so I’ll try to get that to you all.
As for reporting on the actual conference today, I am going to leave that to a future blog so I can do it justice—but here are some key takeaways:
- Darzalex (daratumumab) is awesome, and treating the newly diagnosed with quadruplets is the way to go!
- Twenty-four-hour urine collections are very useful in initial screening, but they may not be necessary in later assessments.
- There were a few abstracts speaking to quicker assessments in relapse, which one would hope will translate into quicker treatment of the patient.
- There was an interesting abstract on the Influenza vaccine; it might benefit MM patients to do a three-dose series rather than the one vaccine, especially if you are on a CD38 monoclonal antibody like Darzalex (daratumumab).
- IVIG (Intravenous immunoglobulin) reduces infections in patients treated with BCMA (B-cell maturation antigen) bispecific antibodies.
- There were a few abstracts on minimal residual disease (MRD) testing, but I’ll write more on that next time!
- And, the last abstract talked about measuring serum BCMA levels in non-secretory disease to monitor for disease progression—it showed some promising results.
That’s my abridged synopsis of day one. Please read this understanding that I am a myeloma patient telling you what I personally understood from all I listened to. I’ll write in a little more detail in the coming days. All in all, a GREAT experience and very heartening and comforting to see all that is being done to enhance the treatment of multiple myeloma patients!
One word: H O P E !!!
@TerryGlassman
