My #ASH24 takeaways

Dec 17, 2024 | Teresa Miceli

The 66th annual American Society of Hematology (ASH) meeting again did not disappoint. Approximately 30,000 people (Health care professionals, pharmaceutical representatives, researchers, and others converged on San Diego, CA, for this premier meeting. I was able to attend many key oral abstracts and education programs related to multiple myeloma. The presentations came like a firehose of information.

My “short” list of key takeaways:

Quadruplet Myeloma Therapies

Not-so-unexpected information was shared that reinforces the benefits of quad therapy in the newly diagnosed myeloma setting.Daratumumab-Based Quadruplet Versus Triplet Induction Regimens in Frontline Transplant-Eligible Newly Diagnosed Multiple Myeloma: A Systematic Review and Meta-Analysis, Abstract 258, Joao Tadeu Damian Souto Filho, MD Faculdade de Medicina de Campos, Campos dos Goytacazes, RJ, Brazil

Isatuximab, Lenalidomide, Bortezomib and Dexamethasone Induction Therapy for Transplant-Eligible Patients with Newly Diagnosed Multiple Myeloma: Final Progression-Free Survival Analysis of Part 1 of an Open-Label, Multicenter, Randomized, Phase 3 Trial (GMMG-HD7), Abstract 769, presented by Hartmut Goldschmidt, MD, Internal Medicine V, GMMG – Study Group at University Hospital Heidelberg, Heidelberg, Germany

Isatuximab, Bortezomib, Lenalidomide, and Dexamethasone (Isa-VRd) in Patients with Newly Diagnosed Multiple Myeloma (NDMM): Analyses of Minimal Residual Disease (MRD) Negativity Dynamics in the Phase 3 Imroz Study, Abstract 770, presented by Robert Z. Orlowski, MD, PhD, Department of Lymphoma & Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX

Phase 3 Randomized Study of Daratumumab (DARA) + Bortezomib, Lenalidomide and Dexamethasone (VRd) Versus Alone in Patients with Transplant-Ineligible Newly Diagnosed Multiple Myeloma or for Whom Transplant Is Not Planned As Initial Therapy: Analysis of Minimal Residual Disease in the Cepheus Trial, Abstract 362, presented by Sonja Zweegman, Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands

Final Analysis of the Randomised UK MRA Myeloma XI+ Trial Examining Krdc (carfilzomib, lenalidomide, dexamethasone and cyclophosphamide) As Induction Therapy for Newly Diagnosed Multiple Myeloma Patients, Abstract 771, presented by Charlotte Pawlyn, PhD, The Institute of Cancer Research, London, United Kingdom

Information related to real-world experience, enhancing patient quality of life, and addressing frailty continues to be highlighted at an increasing volume.

24-Hour Urine Testing Does Not Add Value to Multiple Myeloma Response Assessments: A Secondary Analysis of BMT CTN 0702, Abstract 81, presented by Rahul Banerjee, MD, FACP, University of Washington Fred Hutchinson Cancer Center, Seattle, WA

Balancing Treatment Intervals and Quality of Life in Multiple Myeloma Patients: Patient Perspectives and Recommendations, Abstract 284, presented by Anna Fleischer, Department of Internal Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany

Real-World Characteristics and Outcomes in Patients with Multiple Myeloma Receiving Teclistamab Step-up Doses in Academic Vs. Community Settings, Abstract 933, presented by Adeel M Khan, MD, MS, MPH, Myeloma, Waldenstrom’s, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX

A High-Fiber Dietary Intervention (NUTRIVENTION) in Precursor Plasma Cell Disorders Improves Biomarkers of Disease and May Delay Progression to Myeloma, Abstract 671, presented by Urvi Shah, MD, Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY

Outcomes of Frailty Subgroups Treated with Teclistamab in the Real-World: An International Myeloma Foundation Study Database Analysis, Abstract 704, presented by Hira Mian, MD, McMaster University, Hamilton, ON, Canada

Outcomes of Elderly Patients with Relapsed Refractory Multiple Myeloma (RRMM) Treated with Teclistamab: A Multicenter Study from the U.S. Multiple Myeloma Immunotherapy Consortium, Abstract 934, presented by Oren Pasvolsky, MD, The University of Texas MD Anderson Cancer Center, Houston, TX

Six-Month Resistance Training Interventions Are Associated with Improvements in Fatigue and Pain in Multiple Myeloma Patients, Abstract 705, presented by Janine M. Joseph, MS, MBA, Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY

Lovesick: Examining Couples Health during Myeloma Transplant, Abstract 285, Presented by Ashley Rosko, The Ohio State University, Columbus, OH

The IFM2017-03 Phase 3 Trial: A Dexamethasone Sparing-Regimen with Daratumumab and Lenalidomide for Frail Patients with Newly-Diagnosed Multiple Myeloma, Abstract 774, presented by Salomon Manier, MD, PhD, Lille University Hospital, Lille, France

Smoldering myeloma continues to be an area of controversy about whether to treat or not treat. However, results from the Aquila trial seem to be leading us in the direction of early treatment for high risk smoldering myeloma.

Phase 3 Randomized Study of Daratumumab Monotherapy Versus Active Monitoring in Patients with High-Risk Smoldering Multiple Myeloma: Primary Results of the Aquila Study, Abstract 773, presented by Meletios-Athanasios Dimopoulo, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece

Longitudinal Single-Cell Immune Profiling Reveals Distinct Dynamics of Response to Teclistamab in Patients with High-Risk Smoldering Myeloma Compared to Relapsed-Refractory Multiple Myeloma, Abstract 488, presented by Nayda Bidikian, MD, Broad Institute of MIT and Harvard, Cambridge, MA

Early Safety and Efficacy of CAR-T Cell Therapy in Precursor Myeloma: Results of the CAR-PRISM Study Using Ciltacabtagene Autoleucel in High-Risk Smoldering Myeloma, Abstract 1027, presented by Omar Nadeem, MD, Center for Early Detection and Interception of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA

Advances continue to be made not only in myeloma therapy, but in other domains of the myeloma experience like supportive care and identifying testing that may direct treatment decision-making

Tocilizumab Prophylaxis for Patients with Relapsed or Refractory Multiple Myeloma Treated with Teclistamab, Elranatamab or Talquetamab, Abstract 932, presented by Andrew Kowalski, PharmD, Myeloma Institute, Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL

Eliminating the Need for Sequential Confirmation of Response in Multiple Myeloma, Abstract 83, presented by Jean-Sébastien Claveau, MD, Division of Hematology, Mayo Clinic, Rochester, MN

Patient-Centered Care in Hematology: How Side Effect Severity Influences Decision-Making Autonomy in Relapsed Refractory Multiple Myeloma, Abstract 706, presented by Jay R. Hydren, PhD, Myeloma Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY

A Randomized Trial Demonstrates a 3-Shot Flu Vaccine Series Improves Protection over a Single Shot in Multiple Myeloma, Abstract 255, presented by Dr. Craig Hofmiester, Winship Cancer Institute of Emory University, Atlanta, GA
Conclusion: Increased seroprotection at the end of the season by receiving three Fluzone HD vaccinations at 0, 2, and 4 months compared to a single shot.

Effects of Intravenous Immunoglobulin Supplementation (IVIG) on Infections in Recipients of Teclistamab Therapy for Multiple Myeloma (MM): A Multi-Institutional Study, Abstract 255, presented by Dr. Heloise Cheruvulath, Medical College of Wisconsin, Milwaukee, WI

Early Identification of Functional High Risk Multiple Myeloma Patients after Transplant with Diffusion-Weighted Whole-Body MRI: Predictive Role of Fat Fraction in Addition to RAC Score, Abstract 82, presented by Angelo Belotti, MD, Department of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy

Total Diffusion Volume Evaluated By Whole-Body Diffusion Weighted Magnetic Resonance Image for the Assessment of Tumor Burden in Multiple Myeloma; Relations with Measurable Residual Disease Evaluated By Next-Generation Flow Cytometry and Bone Marrow CD138 Staining Assessed By Qupath, Abstract 491, presented by Kentaro Narita, M.D, Division of Hematology/Oncology, Kameda Medical Center, Kamogawa, Chiba, Japan

Circulating Tumor Cells As a Biomarker to Identify High-Risk Transplant Eligible Myeloma Patients Treated with Bortezomib, Lenalidomide and Dexamethasone with or without Daratumumab during Induction/Consolidation, and Lenalidomide with or without Daratumumab during Maintenance: Results from the Perseus Study, Abstract 487, presented by Luca Bertamini, MD, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands

Reevaluating the IMWG Multiple Myeloma Complete Response Criterion in the Era of Mass Spectrometry: A Critical Analysis, Abstract 489, presented by Noemi Puig, PhD, Hospital Universitario de Salamanca (HUSAL), IBSAL, IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain

A Novel Prognostic System Based on Circulating Tumor Cells for Newly Diagnosed Multiple Myeloma, Abstract 490, presented by Evangelos Terpos, MD, PhD, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Drosia, Attiki, Greece

Pre-Apheresis Prediction of Toxicity and Response in Patients Receiving BCMA-Directed CAR-T for Relapsed/Refractory Multiple Myeloma, Abstract 895, presented by Kai Rejeski, M, Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany

Comprehensive Analysis of Pre-Treatment Biomarkers Associated with Toxicity and Durable Responses in Idecabtagene Vicleucel Therapy for Relapsed/Refractory Multiple Myeloma, Abstract 896, presented by Doris K. Hansen, MD, Department of Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL

Outcomes of Teclistamab (Tec) in Patients with Relapsed/Refractory Multiple Myeloma (RRMM) with Prior Exposure to BCMA-Directed Therapy (BCMA-DT): A Multicenter Study from the U.S. Multiple Myeloma Immunotherapy Consortium, Abstract 897, presented by Danai Dima, MD, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH. “Waiting >9 months between sequencing BCMA therapies may be associated with improved PFS.”

And, finally, an exciting update from the Anito-Cel trial for people with relapsed myeloma

Phase 2 Registrational Study of Anitocabtagene Autoleucel for the Treatment of Patients with Relapsed and/or Refractory Multiple Myeloma: Preliminary Results from the IMMagine-1 Trial, Abstract 1031, presented by Ciara Louise Freeman, PhD, MSc, FRCPC, MRCP, Department of Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL

Many of these and other abstracts will be discussed in greater detail by an amazing panel of myeloma experts at the IMWG Conference Series: Making Sense of Treatment ASH 2024, being held Wednesday, 12/18/2024 at 03:00pm PST.

Dr. Joseph Mikhael, IMF Chief Medical Officer, will be joined by Beth Faiman, PhD, Nikhil Munshi, MD and Vincent Rajkumar, MD, and will discuss advances in myeloma research from the 2024 ASH Conference.

Hear the patient perspective from the Myeloma Voices who attended ASH24 as they share their insights at this webinar: Latest Myeloma Updates from ASH 2024: Easy-to-Understand Insights for Patients and Care Partners on Wednesday, 1/08/2025 03:00pm PST

These and other great events are being planned, including the 2025 Patient and Family Seminars and Regional Community Workshops. Find these and more at Myeloma.org/events.

I want to extend my gratitude to:
The IMF for continuing to include me in this amazing program, Myeloma Voices, where the patient voice is shared through social media to provide updates on myeloma data that impacts those living with this diagnosis. It is a privilege and an honor to attend with this group who volunteers their time to help others living with myeloma.
Our sponsors of Myeloma Voices: Johnson & Johnson, Regeneron, and Karyopharm Therapeutics. Your support of myeloma patients’ learning is much appreciated.
The IMF Meetings and Support Group Teams for all that you do to make this program happen. So many details that others will never know because you do it seamlessly and make it look easy.
The Myeloma Voices, both virtual and in person. You volunteer your time, work through complex information and long schedules to attend the sessions, and share your experiences with your followers.

You can see how visible some of the leaders were at #ASH24, making the Social Media Leaderboard!

You can continue to follow these folks on social media and learn more about #ASH24 and other #myeloma happenings.

Sheri Baker @blondie1746
Yelak Biru @NorthTxMSG
Becky Bosley @MidAtlanticMSG
Barbara Davis @bkinoglu
Jessie Daw @Daw6Jessie
Oya Gilbert @HHHHFoundation
Terry Glassman @TerryGlassman
Linda Huguelet @LindaMyeloma
Teresa Miceli @IMFnurseMyeloma
Rob Salmon @salmon_rob
Jim Shoemaker @JimJhs17
Michael Tuohy @IMFmikeMYELOMA
Robin Tuohy @IMFsupport
Jenn Wieworka @jwiework
Jill Zitzewitz @JillZitzewitz

Search social media for key hashtags: #MMSM #Myeloma #ASH24 #IMFASH24

My best,
Teresa Miceli, RN BSN OCN
Myeloma Voices Nurse Liaison
Support Group Leader
IMF Nurse Leadership Board

The Whirlwind of ASH Slows

Dec 12, 2024 | Becky Bosley

The whirlwind of #ASH24 has slowed down and now it is time to digest all the info we have seen presented. Every year, I find it very important to review IMF Chairperson of the Board Dr. S. Vincent Rajkumar’s updated myeloma treatment algorithms based on the data presented at ASH. It is exciting to see new research implemented into his guidelines yearly. Dr. Rajkumar is careful to say that these are general principles and that treatments evolve and individualized treatment is a priority. He also says that, in general, a clinical trial is preferable if one is possible and available. With a trial, so that more can be learned. So much work in myeloma research across the globe goes into what is presented here at ASH—I”m so grateful to all.

I wanted to start this blog by including a photo of the IMF’s newly formed Scientific Advisory Board (SAB). (It is this blog’s main photo.) I am so proud and excited for their input into research in the future. So much #myeloma greatness in this photograph and more importantly, kindness, integrity, and passion to better the lives of myeloma patients everywhere. Thank you, SAB!

Dr. Rajkumar’s annually updated myeloma treatment algorithms:

Newly diagnosed, transplant ineligible. Quadruplet induction unless frail. Maintenance varies by risk stratification

Mayo Clinic algorithm for newly diagnosed transplant ineligible myeloma patients

Newly diagnosed, transplant eligible. Quadruplet induction.

Mayo Clinic algorithms for newly diagnosed transplant eligible myeloma paitents

First relapse. Dr. Rajkumar doesn’t recommend CAR-T in first relapse, even though it’s approved, except in very selected patients (eg., high risk progressing early while on quad therapy)

Second or later relapse.

True Penta-refractory myeloma (refractory to a proteasome inhibitor, or PI; an immunomodulatory drug, or IMID; a CD38, alkylator; and BCMA-targeted approach):

Mayo Clinic algorithm on refractory multiple myeloma

Saturday Was a Mixed Bag of Interesting News and Study Updates

Dec 8, 2024 | Barbara Davis

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.

First Full Day at ASH, and My Brain Is Full!

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

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