Thank You to Our Sponsors!
What Is Myeloma Action Month? Myeloma Action Month happens every year in March to encourage individuals and groups to take actions that positively impact the myeloma community. The International Myeloma Foundation (IMF) invites YOU to TAKE ACTION because every action makes a difference! This year, the IMF is focusing on actions that individuals and groups can take for the myeloma community to better themselves and to foster community-building
Find more information at: myeloma.org
Audience Q&A
• Open the Q&A window, allowing you to ask questions to the host and panelists. It will be sent to our moderator and panelists for discussion. • If you have a question that does not get answered today, you can contact our Infoline at 800-452-CURE (2873) US & Canada, 1-818-4877455, or email infoline@myeloma.org.
We Want to Hear From You!
Feedback Survey At the close of the meeting a feedback survey will pop up.
This will also be emailed to you shortly after the workshop. Please take a moment to complete this survey.
Todays Agenda *all times are written in Eastern Standard
7:00 – 7:05 PM
Welcome and Introduction Robin Tuohy, Vice President, Support Groups
7:05 – 7:15 PM
Scope of the Problem: Definition of Side Effects and Impact on Current, Future Treatment Kevin Brigle, PhD, ANP
7:15 – 7:25 PM
What are Some of the Newer Drugs and Their Side Effects? Beth Faiman, PhD, MSN, APRN-BC, AOCN, FAAN
7:25 – 7:30 PM
Communicating Side Effects to Your Health Care Team Beth Faiman, PhD, MSN, APRN-BC, AOCN, FAAN and Kevin Brigle, PhD, ANP
7:30 – 7:45 PM
Frequently Asked Questions Beth Faiman, PhD, MSN, APRN-BC, AOCN, FAAN and Kevin Brigle, PhD, ANP
7:45 – 8:00 PM
Live Question and Answer Closing Remarks
Scope of the Problem: Definition of side effects and impact on current and future treatment
Dr. Brigle
Multiple Myeloma: Over Production of Normal Immune –Fighting Proteins, starts in the Bone Marrow Albumin gamma
Extra proteins can clog kidneys, attack bones, and bone marrow
alpha-1
alpha-2
beta
Myeloma and Treatments Both Contribute to How You Feel Myeloma cells in excess can cause symptoms:
Treatments for myeloma can cause symptoms:
• Bone pain
• Peripheral neuropathy
• Peripheral neuropathy
• Fatigue
• Fatigue
• Diarrhea/Constipation
• Infections
• Renal/kidney dysfunction
• Infections • Blood clots • Anxiety/Depression
How You Feel
What happens if Symptoms are not Treated? • Unnecessary pain, neuropathy, GI side effects, infections • Sadness, depression, anxiety, sleep disturbance, loss of
hope, social isolation, reduced quality of life • Reduced doses and missed therapy • Ineffective therapy and disease progression
“Mides” Immunomodulatory drugs (IMIDS)
1/3 Neuropathy (PN) Thrombosis (DVT, PE) Myelosuppression
Low blood counts Heart/Lung Fatigue, weakness
Thalomid® (thalidomide)
Revlimid® Pomalyst® Velcade® (lenalidomide) (pomalidomide) (bortezomib)
✓more with dex ✓ more with dex ✓more with dex
✓ neutropenia
Kyprolis® (carfilzomib)
✓*
✓
✓anemia, neutropenia,
thrombocytopenia
✓ slow heart rate
Ninlaro® (ixazomib) ✓
✓
✓ ✓ neutropenia, ✓ ✓ neutropenia thrombocytopenia thrombocytopenia thrombocytopenia
✓shortness of breath
✓hypotension
✓shortness of breath, hypertension
✓
✓
✓ (incl sedation)
✓
✓
Renal /Kidney
✓
✓
✓
Rash
✓
✓
✓
✓ constipation
✓ diarrhea, constipation
✓ diarrhea, constipation
GI disturbance
“Mibs” Proteasome Inhibitors
✓
✓ nausea, vomiting, diarrhea
✓ nausea, vomiting, diarrhea, constipation
✓ diarrhea, constipation, nausea
“Mabs” Monoclonal Antibodies
2/3
Monoclonal Antibody Drug Conjugate
SINE Compound Xpovio® (selinexor)
Darzalex® (daratumumab)
Empliciti® (elotuzumab)
Sarclisa® (Isatuximab)
Blenrep® (Belantamab Mafodotin)
✓
✓
✓
✓
✓neutropenia
✓neutropenia, thrombocytopenia
Neuropathy (PN) Infusion reaction
Myelosuppression ✓neutropenia, Low blood counts thrombocytopenia Cardiopulmonary (heart/lung) Fatigue, weakness Rash
GI disturbance Other
✓
✓
✓ diarrhea
✓diarrhea, nausea
✓ thrombocytopenia
✓
✓diarrhea, nausea
✓nausea
✓ Anorexia, nausea, vomiting, diarrhea
✓ ocular
✓ hyponatremia
Anthracycline
3/3
Doxil® (liposomal doxorubicin)
Alkylating Agents Cytoxan® NEOSAR®
(cyclophosphamide)
ALKERAN® EVOMELA® (melphalan)
CAR-T Cell Therapy ABECMA® (idecabtagene vicleucel)
CARVYKTI® (ciltacabtagene autoleucel)
Neuropathy (PN)
✓ hypersensitivity ✓ hypersensitivity ✓ hypersensitivity ✓ Prolonged ✓ Prolonged Myelosuppression ✓ anemia, ✓ severe bone neutropenia, neutropenia, (Low blood myelosuppression, marrow ✓ neutropenia thrombocytopenia, thrombocytopenia, counts) immunosuppression suppression anemia anemia ✓ myocarditis, Cardiopulmonary arrythmias, (Heart/lung) pneumonitis Fatigue, weakness ✓ ✓ ✓ ✓ ✓ ✓ nausea, ✓ diarrhea, vomiting, nausea, vomiting, ✓ nausea, vomiting, diarrhea, oral ✓ diarrhea, nausea ✓ diarrhea, nausea GI disturbance diarrhea constipation mucositis Rash ✓ ✓ ✓ ✓ Other CRS, Neurotoxicity CRS, Neurotoxicity Infusion reaction
✓ Acute infusion reactions
✓ hypersensitivity
GI = gastrointestinal; neutropenia = low white blood cell count; PN = peripheral neuropathy; thrombocytopenia = low platelets .
What Symptoms should I look for and report? Kidney (urine)
Bone Pain, Swelling Anywhere
Fatigue
Signs of Infection
Uncontrolled Nausea, Diarrhea, Constipation
Numbness, Tingling, Change in Sensation or Walking
Loss of Appetite
Cough, Breathing Problems, Chest Pain
Sleeplessness, Mood Swings, Depression and Anxiety
What Symptoms should I look for and report?
M ake sure to visit the IM F website for tip cards, understanding series! https://imf-d8-prod.s3.us-west-1.wasabisys.com/resource/MMSuppTipSheets_CJON2017.pdf
Newer drugs and side effects Dr. Faiman
Select Toxicities Of Newer Agents Underscore The Need For Multidisciplinary Support, Patient Education GI toxicity (selinexor, proteasome inhibitors, lenalidomide) Cytokine release syndrome, Neurotox (CART and bispecific T cell engagers)
Myelosuppression, Infection risk, Prolonged cytopenias (cellular therapies, disease)
Patient and Caregiver – Centric, supportive care Ocular toxicity (belantamab mafadotin, corticosteroids
Thrombosis Risk (Immunomodulatory drugs, Carfilzomib, disease) Peripheral neuropathy ( ixazomib, bortezomib, thalidomide)
What are the newest drugs approved since 2020? Drug
How it works
How it is given
Side effects
Xpovio ® - Selinexor
Keeps tumor suppressor proteins in the cell
Pills , once or twice a week at home
Stomach, low blood counts, better when given with other medications
Blenrep ®- Belantamab mafadotin
BCMA
In the vein once every 3 weeks
Need to see an eye doctor before every dose
Sarclisa ®- Isatuximab
Monoclonal antibody CD38
In the vein with pomalidomide, carfilzomib
Infusion reaction risk
ABECMA® idecaptagene vicleucel
CAR T-cell therapy
A patient’s cells are taken through a machine, made into “CARS”; reinfused 4-6 weeks
Cytokine release syndrome, low blood counts can stay around, infection risk
CILTACEL® ciltacabtagene autoleucel
CAR T-cell therapy
A patient’s cells are taken through a machine, made into “CARS”; reinfused 4-6 weeks
Similar to ABECMA
Selinexor Oral nuclear export inhibitor: blocks tumor cells from exporting tumor suppressor proteins → selective apoptosis of tumor cells First month, most challenging Symptoms decrease for most with time • Low blood counts (weekly blood counts in cycle 1) • Prevent nausea and anorexia (start ondansetron day 1; olanzapine ) • Low sodium (salty snacks, oral hydration) • Diarrhea risk (oral hydration)
Belantamab Mafodotin Antibody against BCMA Can kill myeloma cells in multiple ways: • Antibody targets cytotoxic drug to myeloma cells • Antibody can recruit immune cells to kill myeloma cells
Given IV once every 3 weeks, over 30 minutes Eye exam under slit lamp, “Snellen chart” before every dose Avoid contact lenses and apply eye drops 4 times a day
Isatuximab and Daratumumab Hyaluronidase Daratumumab Hyaluronidase SC:Anti CD-38 Safety and dosing Infusion reactions less common with the shot than IV: low blood counts, infusion reaction risk, infections, stomach
Isatuximab IV: Anti CD-38 Safety and dosing Infusion reactions: the most-common reactions specific to isatuximab are mild: low blood counts, infusion reaction risk, infections, stomach
Monitor for 4 hrs after first shot Weekly for 8 weeks then every 2 weeks, then monthly
Slower first and second infusions weekly for 4 weeks then every 2 weeks
Shingles protection and premedication
Shingles protection and premedication
Newest Approvals- Chimeric Antigen Receptor T-Cell (CART) therapy Both highly effective cellular therapies for relapsed and refractory multiple myeloma against B-Cell maturation Antigen (BCMA) CARVYKTI ® - (ciltacabtagene autoleucel) •
Approved February 28, 2022
•
After 4 prior therapies
ABECMA® - (idecabtagene vicleucel) •
Approved March 27, 2021
•
After 3 prior therapies
Patient CAR-T Therapy Journey: Two Anti-BCMA Therapies Approved!!! Patient with multiple prior therapies
Consult with CAR-T Center/MM Specialist
CAR-T Treatment Decision
Caregiver role throughout CAR-T
Patient Waits ~4-6 weeks while Lab Grows Engineered T cells
Monitor Remain near CAR-T center up to 4 weeks
Harvest T Cells
Lab Engineers T Cells
Caregiver Monitors for Signs of CRS and NT • • Fever, fatigue, malaise, sleepiness • • Low oxygen saturation • Abnormal heart rate
Nausea, vomiting, diarrhea Headache, confusion, delirium, language disturbance, trouble 23 swallowing
Side effects of Abecma Kidney serum creatinine Renal insufficiency TLS
Liver Transaminitis ALP Hyperbilirubinemia
Lung Hypoxia Dyspnea Capillary leak syndrome Heart Sinus tachycardia Hypotension Arrhythmias General Fever Fatigue, malaise Headache
Gastrointestinal Nausea Vomiting Diarrhea
• Monitor vital signs, Labs • Antibiotics • Protocol if need to go to ER • Early referral
Blood Anemia Thrombocytopenia Neutropenia
CRS
Musculoskeletal CPK Myalgia Weakness
CAR-T patient’s own T cells engineered in 4 to 6 weeks – Will often need treatment in between
Neurologic Delirium Sleepy Swallowing
Communicating Side Effects to Your Health Care Team Dr. Brigle & Dr. Faiman
Know your Team! Look to them for Support Primary Hematologist, Oncologist
Advanced Practice Providers
Pharmacists
Allied Health Staff/ Triage
Radiation Oncology
Psychiatry
Physical Therapy
Palliative Medicine
Primary Care Provider (PCP)
Subspecialists (nephrology, cardiology)
Family/Support Network, Religious, Support group
Financial Navigator
Tips for talking with your provider
Navigating to IMF Publications mail-order or download 1
Go to myeloma.org
2
Select Pubs & Videos
3
Click on IMF Publications
5
5
4
Select the Understanding Series or Tip Cards
Download the Desired Publication
Frequently Asked Questions 7:30-7:45PM EST
Audience Q&A
• Open the Q&A window, allowing you to ask questions to the host and panelists. It will be sent to our moderator and panelists for discussion. • If you have a question that does not get answered today, you can contact our Infoline at 800-452-CURE (2873) US & Canada, 1-818-4877455, or email infoline@myeloma.org.
We Want to Hear From You!
Feedback Survey At the close of the meeting a feedback survey will pop up.
This will also be emailed to you shortly after the workshop. Please take a moment to complete this survey.
Thank You to Our Sponsors!