Practice Changes, Key Takeaways, and Closing Remarks

Closing the program, Surbhi Sidana, MD, asks each panelist what has changed most in her practice this year. Doris Hansen, MD, points to more deliberate bridging, now often extending to 2 cycles or 2 months rather than 1, and to earlier recognition and intervention for delayed toxicities, citing new data on triplet intrathecal chemotherapy and early high-dose steroids for parkinsonism, a role for an elevated absolute lymphocyte count of 3,000 or greater in predicting delayed neurotoxicity, and a shift from tumor necrosis factor alpha inhibitors toward Janus kinase inhibitors and T-cell-directed therapies such as cyclophosphamide and cyclosporine for immune effector cell enterocolitis. Prerna Mewawalla, MD, highlights the broader shift in second-line myeloma treatment toward bispecific antibodies, chimeric antigen receptor (CAR) T-cell therapy, and antibody-drug conjugates in place of traditional chemotherapy, and states that her main message to the audience is to refer patients early, ideally at diagnosis or at least at first relapse, since any treatment is only as good as a patient’s access to it. Dr. Sidana agrees, noting a similar shift toward immunotherapy at first relapse in her own clinic, and closes by thanking both panelists for a discussion spanning sequencing, toxicity monitoring, and care coordination between community and treating centers.