A panel of experts present a profile of a patient with newly diagnosed multiple myeloma (NDMM) and offer their initial thoughts.
Ola Landgren, MD, PhD: Welcome to this Cancer Network® Around the Practice® program titled “Advances in Multiple Myeloma: Insights from Experts at University of Miami Health System.” I’m your host, Ola Landgren. I’m a professor of medicine, the chief of the division of multiple myeloma, and the leader of the translational and clinical oncology program at the Sylvester Comprehensive Cancer Center [in Miami, Florida]. I have a great panel of experts joining me. I’d like to invite my esteemed fellow panelists to introduce themselves. Dickran?
Dickran Kazandjian, MD: I’m Dickran Kazandjian, and I’m a professor of medicine at the University of Miami and an associate director for clinical trials and research at the Sylvester Myeloma Institute.
Ola Landgren, MD, PhD: Ben?
Benjamin Diamond, MD: Hi, I’m Ben Diamond. I’m an assistant professor of medicine at the Sylvester Myeloma Institute.
Dennis Verducci, APRN: My name is Dennis Verducci. I’m a nurse practitioner at the Sylvester Myeloma Institute.
Ola Landgren, MD, PhD: Thank you for joining me. We’re going to discuss several key data updates in multiple myeloma from recent meetings and publications. We’ll review these data in the context of the treatment landscape for multiple myeloma and discuss how we can apply the evidence to our clinical practice to improve patient outcomes. Let’s start by reviewing a patient case.
This is a 61-year-old woman who presented with rib pain in February 2021. A chest x-ray revealed several lytic lesions. The patient came in with some coughing, and [the x-ray] was to rule out evidence of pneumonia. She had well-controlled diabetes and mild hypertension at the time of this visit. The patient subsequently was worked up to [see] what was going on with regard to these lytic lesions. A bone marrow biopsy revealed sheets of small- to medium-sized plasma cells. They were found to be kappa light chain restricted. The bone marrow biopsy showed that about 40% of the cells were light chain restricted plasma cells in the bone marrow.
Additional blood work was done with hemoglobin showing 9.3 g/dL. Calcium was 9.1 mg/dL. Creatinine was 1.3 mg/dL. Kappa free light chains were 120 mg/dL. Lambda was normal. There was no abnormal monoclonal protein, either by SPEP [serum protein electrophoresis] nor IFE [immunofixation]. Beta-2-microglobulin was 4.0 mg/L. Albumin was 4.0 g/dL. Bone marrow results came back later showing evidence of a t(4;14) translocation. This was found in about 20% of the plasma cells.
This patient was started on a combination of daratumumab, bortezomib, lenalidomide, and dexamethasone. After 4 cycles, the patient obtained a partial response, and this was reflected in free light chains of 30 mg/dL. A repeat bone marrow biopsy was done at this time, after 4 cycles, and showed 10% plasma cells. The patient was referred for evaluation for a bone marrow transplant. What would you do next, Ben?
Benjamin Diamond, MD: We see that the patient had a partial response to therapy, and it’s only been about 4 cycles. We definitely want to see how deep we can go. At this point, after the transplant evaluation, we’d harvest the stem cells to make sure that we have them on reserve and we’d continue therapy so we can then—after about 4 more cycles—perform a restaging and decide what to do next.
Ola Landgren, MD, PhD: Dennis, do you have anything you would like to add?
Dennis Verducci, APRN: No, I agree with Ben. I’d definitely do another bone marrow biopsy, and I’d also do a PET [positron emission tomography]–CT after 8 cycles. If the patient has achieved MRD [minimal residual disease] negativity and there’s no evidence of disease, it’s very reasonable to forego transplant.
Ola Landgren, MD, PhD: These are controversial topics that we’re already bringing up. We’ll continue to discuss a lot of the controversial topics happening in the field because there’s so much change. There are so many new therapies and technologies to evaluate response. We’re talking about MRD tracking of patients in the newly diagnosed setting but also in the relapse setting.
Transcript edited for clarity.