Post-ASH Reflections/Highlights Days 2 & 3

Post-ASH Reflections/Highlights Days 2 & 3

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!

New Words: I Feel Smarter Already!

New Words: I Feel Smarter Already!

Dec 7, 2024 | Barbara Davis

The first day is kind of a beginner’s day, with a number of Continuing Medical Education (CME) courses/presentations. I went to two: The first was Championing the Care of Relapsed/Refractory Multiple Myeloma: Practical Strategies to Integrate Bispecific Antibodies, and it was presented by Drs. Ajai Chari and Amitra Krishnan. Here are some of its key points:

  • Heavily pretreated relapsed/refractory (R/R) patients will continue to fail more and more drugs
  • In the HORIZON study, there were three bispecific antibodies: linvoseltamab, Tecvayli (teclistamab), and Talvey (talquetamab) used, each in a different arm of the study. Patients were heavily pretreated relapsed-treated MM patients, yet, they still each had an overall response rate (ORR) of over 60%
  • Oral and skin toxicities were higher with talquetamab, but the infection rate was lower. Both doctors agreed that patients must be warned about skin problems. Also dysgeusia (my new favorite word, means abnormal taste), weight loss, and (rarely) cerebellar ataxia (poor muscle coordination).
  • They discussed how to choose between CAR T-cell therapy and bispecific antibodiess? Timing is very important. Dr. Chari said to consider the time from “brain to vein,” meaning the time when the doctor first thinks about putting a patient into the CAR T list to when the patient’s T cells are reinfused is long. So, the question is can the patient last long enough, or is their disease rapidly progressing? In the latter case, a bispecific antibody would be the better choice.
  • There’s still much learning to be done about sequencing these new therapies. “More questions than answers,” said Dr. Chari.
  • Management of key toxicities is extremely important. Clinicians must treat for cytokine release symptoms (CRS) as the first symptom. Also, infection management must be done at first onset, often giving IVIG as soon as treatment is started.
  • “Bispecific antibodies will become as routine as Darazalex (daratumumab) now,” said Dr. Krishnan.
  • Bispecifics and other MM drug combos are currently off-label.
    Phew! It was an interesting discussion, and I was pleased that I understood so much. The next session was a bit harder, but I’ll tackle that report tomorrow. It was about Optimizing CD38 antibody-based triplet regimens for early relapse MM. For my fellow patients, you probably know that early relapse is a signal that your myeloma is showing itself to be high- risk. That sounds scary; and it is scary, but I was also impressed that so much energy is being put into drug development and clinical trials to learn how to successfully treat the high-risk patient.
Looking for the Light at ASH!

Looking for the Light at ASH!

Dec 2, 2024 | Terry Glassman

I was diagnosed with Multiple Myeloma/Plasma Cell Leukemia (MM/PCL) in November 2022. For a solid 2 months, I was a bit paralyzed by my diagnosis, and the induction road was rocky. Yet, eventually, things smoothed out and I started my quest to learn all I could learn and then started reaching out to help others. As an RN, my learning curve was a bit shorter than most, but there is SO much to learn about MM! I’d say at this point, I have a decent understanding of the disease, but there is always more to learn and thankfully new information/treatments/medications keep coming. I am so honored and excited to attend ASH with the IMF as it is the ultimate meeting in Hematology/Oncology and, being the nerd I am, I can’t wait to learn and share!

My goal as an IMF Voice at ASH is to learn as much as possible and share that knowledge with all my fellow MM Patients. As a high-risk patient myself, I’ll put an emphasis on presentations that focus on the high-risk population. I am also very interested in how MRD (Minimal Residual Disease) testing may affect or change the landscape of MM treatment and research studies. I have experience in research, albeit as a cardiac research nurse, so the potential of MRD Negativity as an endpoint to facilitate research intrigues me. Another area of personal interest is decreasing the dose of dexamethasone. I’m not sure if this topic, will be discussed but if it is…I’ll be there. I was one of those people who took 40mg of Dex for 5 days; and yes, it made its mark in a very negative manner! And finally, I look forward to what’s new and on the horizon.

I have found that even when you think people understand the MM Journey, they don’t. I’m sure we all have people who we have explained MM to only to have them say a few months later “So, when are you finished with chemo”? If my attendance at ASH can help others better understand MM, while also helping to keep my fellow MM patients updated, then it’s a huge win/win! The biggest fear I had when I was diagnosed was that I would lose my ability to help people. My involvement with the IMF has given me the ability to regain what I cherish most in life…helping others! So again, I thank the IMF for this amazing opportunity to learn from those who work so diligently for us all! In the words of my MM Specialist: “the longer I keep you alive, the longer I can keep you alive.” I am sure that sentiment is in the minds of all these amazing scientists, and I look forward to learning from them all! SCIENCE, IT’S LIKE MAGIC, BUT REAL!

~Terry Glassman~
@TerryGlassman