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Welcome and Announcements
Kelly Cox, Senior Director Regional Community Workshops 2
Thank you to our sponsors!
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Workshop Video Replay & Slides As follow up to today's workshop, we will have the speaker slides and a video replay available. These will be provided to you shortly after the workshop concludes.
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Indiana and Illinois Area REGIONAL COMMUNITY WORKSHOP Saturday August 7, 2021~ Agenda
Welcome and Announcements Kelly Cox, Senior Director Regional Community Workshops Myeloma 101 and Frontline Therapy Rafat Abonour, MD, Indiana University School of Medicine, Indianapolis, IN Q & A with Panel Stretch Break Relapsed Therapy and Clinical Trials Agne Paner, MD, Rush University Medical Center, Chicago IL Q & A with Panelist How to Manage Myeloma Symptoms and Side Effects Kathleen Colson, RN, BSN, BS, IMF Nurse Leadership Board, Dana-Farber Cancer Institute, Boston, MA Q&A with Panel
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Myeloma 101 and Frontline Therapy
Rafat Abonour, MD, Indiana University School of Medicine, Indianapolis, IN 7
Multiple Myeloma Overview Rafat Abonour, M.D. Harry and Edith Gladstein Professor of Cancer Research
Multiple Myeloma: The First Recognized Case • A 39 year old woman developed severe back pain in 1840. • Two years later she developed severe pain while her husband was carrying her from the fireplace area to the bed. • A bitter infusion for her poor appetite was given, but the patient refused it. • Two years later she was admitted to St. Thomas Hospital and was allowed wine, mutton chop, and a pint of porter daily.
The First Recognized Patient
Sara Newberry first published pt in 1844, by Dr. S. Solly, termed condition Mollities Ossium
Multiple Myeloma in 1844
• • •
Despite the infusion of orange peel and giving rhubarb pills, she died five days later and autopsy was performed. Section of the bones revealed marked destruction. The majority of the nucleated cells had a clear oval outline with 1-2 nucleoli. Solly believed the process to be inflammatory and that it has begun with a morbid action of blood vessels in which an earthy matter of the bone is absorbed and thrown out by the kidneys and the urine.
•
Solly, 1844:Remarks on the pathology of mollities ossium with cases. Medical and Chirurgical Transaction of London, 27, 435-61.
The Cells seen by Sir Solly
CP1123175-2
Plasma cells make antibodies (immunoglobulin) to fight bacteria and viruses
B cell
Plasma cell
SURVEILLANCE “RIGHT FIT”
REPLICATION & MASSIVE ANTIBODY PRODUCTION
Myeloma is a cancer of plasma cells • Myeloma = too many plasma cells • Each myeloma cell (clone) makes and releases one type of antibody (gamma globulin) into the circulation (monoclonal gammopathy)
Potential Causes of MGUS/Myeloma New Data • Detailed studies of toxic chemicals with metaanalyses* Clear links to cancer Roundup (glyphosphate)/benzene/PFAs implicated** Also data on : 1,3-butadiene, ethylene oxide, vinyl chloride/bromide • Younger age (25-49 years) linked to higher risk and obesity*** *Zhang et al (Berkeley) mutation research, 2019 Teras et al (American Cancer Society) Int J of Cancer, 2019 EPA 2019: IARC reports **Perfluoroalkyl compounds in cooking pots, shampoos, makeup ***See blog: Obesity, myeloma and younger age of onset
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Myeloma Baseline Testing Test 1. 2. 3. 4. 5.
M-spike (SPEP; UPEP; IFE) Complete blood count Full chemistry panel Freelite Serum β2 microglobulin and LDH (for ISS staging) 6. Bone marrow (% PC; FiSH) 7. Imaging (X-ray; CT; MRI; PET)
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Detecting the monoclonal protein in the serum of Multiple Myeloma Patients Serum Protein electrophoresis (sPEP)
Normal profile
MAYO CLIN PROC. 2001;76:476-487 © 2001 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
Monoclonal protein = M-spike
Role of Mass Spectrometry 1. Very sensitive test for M-component measurement 2. Practical commercial method 3. Also identifies MoAbs 4. Will change diagnostic/response criteria 5. Affordable (projected: $180) blood test … can become new endpoint for response, “biochemical relapse” and maybe MRD testing!
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With mass spec… M-Protein and Dara Both Detecte 231
Old
SPEP
0.29 g/ dL dL 0.31 g/ 0.32 g/dL
Serum Protein Electropho resis
Immunofix ation
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7000
4000 50006000
2511 9000
16 10 6000 8000 3500 5000 4000
5000 3000
2500 30004000 KAPPA KAPPA KAPPA KAPPA
Mass Fix
4000
914 20 7000 8 12
GAMMA
Dara Dara M-Prot M-Prot
KAPPA
4 32 1
GAMMA GAMMA GAMMA
KAPPA KAPPA KAPPA
M-Prot
6000 7
50006
3000 2000
3000
2000
1500
M-Prot
8 5 4000
Dara Dara
10 46
2000 3000 2000
1000 1000
1000 1000
500
0 0 0 0
2 143
1510
GAM M A GAM M A (10^3) GAM M AM (10^3) GAM A (10^3)
New
IFE
3 4 2000
52 2 1000 1 0 00 0
10.5 10.5 10.5 10.5
11.0 11.0 11.0 11.0
11.5 11.5 11.5 11.5
m/z
12.0 12.012.0 12.0
M-Prot
Dara
12.5 12.512.5 12.5
m/z
10 M-Protein : 90 Dara 50 M-Protein : 50 Dara No Dara90 M-Protein : 10 Dara
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Myeloma Bone Disease
Myeloma in hand
Myeloma in the orbit
MRI (with contrast or STR images) very useful to delineate problems
Staging with FDG-PET/CT and MRI PET
MRI
PET: Focal lesions F
F
F
D D D D
D
F
D
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Recommended Imaging Old
New
Traditional skeletal survey with x-rays
WBLDCT
PET/CT
Best for early screening for bone disease
Response assessmen t: active residual disease
MRI
WB/spine + pelvis
Gold standard to assess bone marrow involvement 25
FiSH
Fluorescent in Situ Hybridization
GEP
Gene Expression Profiling
High risk FiSH
High risk GEP
t(4;14), 17p –, t(14;16), t(14;20), 1q +
70 gene profile
Drach J, ASH 2012
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Risk Assessments
New
High Risk Classification • 17p-/p53 mutations • t(4;14) • 1q+ • t(14;16) or t(14;20) • Double hit – 2 high risk factors (e.g. 17p- plus 1q) • Triple hit – 3 high risk factors
No clear guidelin es
Management Strategies • No upfront approach yet • Treat at relapse < 12 months • Explore new regimens 27
Impact of Cytogenetic/ FISH based stratification P < 0.001 Proportion surviving
FISH Standard risk (86%, median OS=NR)
FISH High risk (14 %, median OS= 3 years)
Follow up from Diagnosis (years) High risk abnormalities t (4, 14), t (14;16), t(14;20) Deletion 13q/ monosomy 13 (metaphase cytogenetics) Del 17p Del 1p/ Amp 1q Kumar S, Blood. 2012;119(9):2100-2105
In the absence of trisomies
Natural History
Kyle et al, NEJM, Volume 356:2582-2590, June 21, 2007
Progression to Symptomatic MM
Kyle et al, NEJM, Volume 356:2582-2590, June 21, 2007
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Baseline Testing Required for Myeloma Diagnosis MGUS
Smoldering
Early Active
Active Myeloma
Spike on SPEP/UPEP Abnormal Freelite Bone Marrow <10% PC Spike ≥ 2 G/dl Freelite ratio ≥ 20% Bone Marrow ≥ 20% PC
MGUS
HR SMM
Bone Marrow ≥ 60% PC
1
Freelite Ratio ≥ 100
2
Creatinine Clearance < 40 mi/min
3
MRI 2 or more lesions
4
M DE
Calcium Elevation
C
Renal dysfunction: Creatinine Elevation
R
Anemia
A
Bone Lesions:
B
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Indications for Considering Treatment (IMWG Guidelines) •
• • • •
At least one of the CRAB Criteria (evidence of end organ damage) Hypercalcemia
Serum calcium >2.75 mmol/L (>11 mg/dL)
Renal Failure
Serum creatinine ≥ 2 mg/dL or creatinine clearance <40 mL per min
Anemia
Hemoglobin >20 g/L below the lower limit of normal, or a hemoglobin value <100 g/L
Bone
Lytic lesions, pathologic fractures, or severe osteopenia
≥60% clonal bone marrow plasma cells Serum involved/uninvolved free light chain ratio ≥100 >1 Focal bone lesion (≥5mm) on MRI Use your Clinical judgment when using these criteria Rajkumar, et al. Lancet Oncology. 2014;15(12):e538-48.
Revised International Staging System for Multiple Myeloma
Prognostic Factor ISS Stage
• I -Serum β2-microglobulin <3.5 mg/L, serum albumin >3.5 g/dL • II- Not ISS stage I or III • III- Serum 2-microglobulin >5.5 mg/L
AND/OR LDH
Normal Serum LDH: <the upper limit of normal High Serum LDH: > the upper limit of normal
AND/OR Cytogenetic*
High Risk: • del(17p) • t(4;14) • t(14;16) Standard risk No high-risk CA
Stage I
Intermediate Risk
Stage III
ISS Stage I
ISS Stage II
ISS Stage III
AND Normal AND No high Risk
AND
Not R-ISS Stage I or III
*Based on the Updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines 2013 Mikhael JR et al. Mayo Clin Proc. 2013;88:360.
High AND/OR High Risk
New Criteria for HR SMM • M-component level ≥ 2 gm/dl • BMPC ≥ 20%
2 or more
• sFLC ratio (involved/uninvolved) ≥ 20 • Presence of 1q+ and/or 13q- confers added risk *Mayo team: Blood Cancer Journal 8:59 2018. Risk stratification based upon 421 patients. Follow up for ~3000 patients being finished.
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Risk of Progression for SMM 2/20/20 plus 1q+/ 13q-
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The Future of Myeloma Therapy MM MGU S
HR SMM
Low risk High riskLow risk New HR Ultra MGUS MGUS SMM SMM high risk 2/20/ 20
Monitor
MD E
New CR AB
HR BR
Treat as MM
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Current Therapies Frontline • Rd: Revlimid dex Vd: Velcade dex • VRd: Velcade Revlimid dex KRd: Kyprolis Revlimid dex • DRD • DKRD • ASCT: autologous stem cell transplant
Maintenanc e Revlimid ± Proteasome Inhibitor
…. Plus new agents in trials
Relapse • • • • • • • • • • •
Daratumumab Carfilzomib Isattximab Pomalidomide Elotuzimab Ixazomib Belantamab Selinexor Idecabtagene Cyclophosphamide VDT-PACE
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Multiple Myeloma in 2021 • Testing including novel laboratory testing and better imaging may help detect myeloma at earlier stages • We are working on treating early myeloma with hope for curing myeloma before causing irreversible harm to the patients • Depth of response is very important, getting rid of myeloma makes you live longer • Patients are living much longer due to the use of combination therapies and eradicating minimal residual disease
Audience Q&A with Panel
Type and submit your questions here. Click the Q&A icon circled below if you have minimized the Ask Question window.
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BREAK 10 minutes 41
Agenda After the Break Relapsed Therapy and Clinical Trials Agne Paner, MD, Rush University Medical Center, Chicago, IL Q & A with Panelist How to Manage Myeloma Symptoms and Side Effects Kathleen Colson, RN, BSN, BS, IMF Nurse Leadership Board, Dana-Farber Cancer Institute, Boston, MA Q&A with Panel
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Relapsed Therapy and Clinical Trials Agne Paner, MD, Rush University Medical Center, Chicago, IL 43
Clinical trials and treatment of relapsed Multiple Myeloma
Agne Paner, MD Associate Professor of Medicine Director of Multiple Myeloma and Amyloidosis Program Rush University Cancer Center August 7th, 2021
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What we will cover • • •
Why do we do clinical trials ABCs of clinical trials Updates in treatment of relapsed multiple myeloma: •
Comparing different anti-BCMA therapies
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Why do we do clinical trials? Patients ask…
Research question…
• How did I get MM?
• What causes MM?
• What is my stage?
• How can we predict prognosis?
• Will I pass it to my children?
• Is there genetic predisposition to MM?
• What can I do about my cancer? • Should I participate in a clinical trials?
• Which treatment option is the best? • Can we improve current standard of care or explore new treatments?
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Advances and Improvement in Survival in MM over the time Elotuzumab Daratumumab Bortezomib Panobinostat Lenalidomide Ixazomib Thalidomide Pomalidomide Melphalan Corticosteroids
1958
1962
DaraPomDE loPomD
Melflufen Car T Cell: Ide-Cel Selinexor
Carfilzomib
ASCT
1983
DaraLenD DaraBorD
Belnatamab 1999
2002
Median OS 64mo
72mo
2012 2015 2013
2016 2018 2019
2020
2021
29.9mo <12mo 1958
1971-1998
2001-2005
2006-2011
2015-
Kumar, et al. Leukemia. 2014;28:1122-1128. Kumar, et al. Blood. 2008;111:2516-2520.
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All the treatments we have today are a result of clinical trials Preclinical research:
Trials with humans: Phase I – is it safe? Phase II – how many will respond? Phase III –Is new treatment better than standard?
Laboratory research Animal models
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Road blocks in myeloma journey:
Natural history and treatment course of MM: ASCT transplant Maintenance
Newly diagnosed
Early relapse
Multiple relapses
Nature of trials by timeline: Phase III Is new treatment better than what is standard?
Phase I/II Is it safe, do patients respond? 49
Terminology in the clinical trials • What phase is the trial • What patient population participated in the trial • Randomized: computer decides which treatment patient will receive • Overall Response Rate: how many patients had at least 50% reduction in tumor • Progression free survival: how long patient remained in remission • Duration of response: how long patients who responded remained in remission • Overall survival: how long patients lived after starting this treatment • Adverse events: side effects during clinical trial
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Classification of drugs available for treatment of MM
Alkylators
Imids
Proteasome Anti-CD38 inhibitors Monoclonal Abs
Anti-BCMA therapies
XPO1 inhibitor
Melphalan
Thalidomide
Bortezomib
Belantamab mefadotin
Selinexor
Cyclophosphomide
Lenalidomide
Ixazomib
Car-T cells
Bendamustine
Pomalidomide
Carfilzomib
BiTes
Melflufen (melphalan flufenamide)
Daratumumab
Isatuximab
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Therapies targeting BCMA: BCMA-targeting modalities Antibody-drug conjugate
T-cell activating strategies CAR T-cell therapy
Bispecific antibody
BCMA, B-cell maturation antigen; CAR, chimeric antigen receptor. Cho SF et al. Front Immunol. 2018;9:1821. doi:10.3389/fimmu.2018.01821.
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How does it work: Belantamab mefadotin
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Things to know: Belantamab • In a phase 2 clinical trial patients refractory to three prior lines of therapy, including Imids, proteasome inhibitors and daratumumab had 30% response rate. • Among patient who responded (DOR), remission lasted about a year. • Belantamab can cause: • dry eyes, • impaired vision • changes in the lining of cornea, that may not cause symptoms, but can be seen on a slit lamp exam.
• Eye exam required every 3 weeks • Eyes recover when drug is held and patients can be treated again. • Holding drug is safe – vast majority of patient remain in remission while holding drug for eye side effects. Lancet Onocology 2020
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Strengths and weaknesses: Belantamab Strengths
Weaknesses
Easy access, available in each office
Ongoing therapy
Convenient schedule: intravenous 30min infusion every 3 weeks
Side effect of dry eyes and impaired vision
Well tolerated except for side effects for eyes
Requires eye exam every 3 weeks by eye care professional
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How does it work: BiTes (Bispecific T cell engagers)
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Things to know: BiTes • Currently in clinical trials only • Administered intravenously or Sq, weekly-every three weeks. • Response rates range from 60-70% • During initial cycles can cause cytokine release syndrome (CRS) • Can cause neurotoxicity
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Strengths and weaknesses: BiTes Strengths
Weaknesses
Currently available only through clinical trials
Ongoing therapy
High response rates Too early to say how long remission will last
Risk of CRS with first cycles
Schedule varies from weekly to every three weeks. Administered IV or SQ
Risk of neurotoxicity (ICANS)
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How does it work:
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Things to Know: Ide-Cel • First FDA approved anti-BCMA Car T-cell for treatment of RRMM • CarTcells are one time administration treatment, but require hospitalization. • Only approved centers can administer CarTcells • After collection of Tcells, it takes about a month to manufacture them. Bridging therapy may be needed. • Response rate 73%: • 26% of patient with very deep, MRD negative response
• PFS 8.8months • Cytokine release syndrome in 84% of patients, but mostly mild • 18% with neurotoxicity NEJM 2021
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Strengths and weaknesses: Car T cells Strengths
Weaknesses
One and done treatment
Requires hospital admission
High response rates and duration of response
Logistics can be difficult: Need to travel to specialized center Delays due to manufacturing shortage Risk of CRS
Risk of neurotoxicity (ICANS)
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Upcoming therapies: Cilta-Cel • Cilta-cel, a CAR T-cell therapy with two BCMA–targeting singledomain antibodies • Response rate 97%, majority very deep response (MRD negative 91% among 61 evaluable) • Duration of response 21months • Cytokine release syndrome in 94% of patients, but mostly mild • Neurotoxicity in 20%
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Future directions • Novel therapies in combination of FDA approved therapies: DREAM5 trial at RUMC • Introducing anti-BCMA therapies, including CarTcells in earlier lines of treatment. • New targets different from BCMA for novel immunotherapies.
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Thank you agne_paner@rush.edu
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How to Manage Myeloma Symptoms and Side Effects Kathleen Colson, RN, BSN, BS, IMF Nurse Leadership Board, Dana-Farber Cancer Institute, Boston, MA 66
Be the Commander of Your Galactic Journey: Navigating the Journey Kathleen Colson, RN, BSN, BS Dana-Farber Cancer Institute Regional Community Workshop – IL, IN August 7, 2021
Patient Education Slides 2021
You are in the Commander’s Chair
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All Crew Members are Needed for a Successful Journey
Navigating the Journey
• You and your Subspecialists
Primary Care Provider (PCP)
caregiver are the center
General Hem/Onc
• Understand the
different roles of your health care team
You and Your Caregiver(s)
Family/Support Network
Allied Health Staff
Myeloma Specialist
• Understand how they can help you
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Be an Empowered Patient “Scotty, We Need More Power!” • Participate in decisions • Ask for time to consider options (if needed/appropriate)
• Understand options - Use reliable sources of information - Use caution considering stories of personal experiences
• Create a dialogue • Express your goals/values/preferences • Arrive at a treatment decision together
Navigating the Journey
HCP Clinical Experience
Data From Research TREATMENT DECISION
Your Preference Philippe Moreau. ASH 2015.
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Preparation for Appointments in the COVID Era
Health in the COVID Era
Preparation
Appointment
Back Home
• Write down your questions and concerns including about COVID • Bring current medications and supplements • Any medical or life changes since your last visit? • Current symptoms - how have they changed?
• Remember your mask • Ask your most important questions first • Understand your treatment plan and next steps • Have a list of who to contact and when • Include a Caregiver for another “set of ears”
• Take precautions to stay healthy • Communicate with other members of your health care team (pharmacist, others) • Take your medications as directed • Follow up with members of your heath care crew
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Consider Telemedicine Visits
Tune Up Health in the Your COVID Era Knowledge
• Check with your healthcare provider(s) to see if telemedicine is an option • Plan as if for an in-person appointment PLUS – Ask provider for telemedicine process (tips/info, how to make appt, if any copay needed, etc.) – Plan your labs: are they needed in advance? Do you need a script? – Plan your technology: smartphone or tablet with camera are preferred – Plan your location: strong wifi, quiet, well-lit location is best – Plan yourself: consider if you may need to show a body part and wear accessible clothing – Collect recent vital signs (blood pressure, temp, heart rate) self-serve blood pressure cuff is available at many pharmacies – At the end of the visit: check future appointments (virtual or in-person), testing, medication refills
IMF Telemedicine Tip Sheet. In development.
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Infection Prevention & Treatment • Compromised immune function comes from multiple myeloma and from treatment • Good personal hygiene (skin, oral) • Environmental control (wash hands, avoid crowds and sick people, etc) • Growth factor (Neupogen [filgrastim]) • Immunizations (NO live vaccines) • Medications (antibacterial, antiviral)
Health in the COVID Era
Report fever of more than 100.4°F, shaking chills even without fever, dizziness, shortness of breath, low blood pressure to HCP as directed. Infection is serious for myeloma patients!
– New research: for patients receiving active myeloma therapy, levofloxacin 500 mg once daily for 12 weeks reduced infection (fevers, death) (ASH 2017 #903)
Brigle K, et al. CJON. 2017; 21(5)suppl:60-76.
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The Best Way to Prevent Illness Is to Avoid Being Exposed • Virus spreads from person-to-person through respiratory droplets • Respiratory droplets are from coughs, sneezes, talking of an infected person – More droplets with louder talking, yelling, singing
• Close contact (within 6 feet) increases risk of spread • Droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs • COVID-19 may be spread by people who are not showing symptoms COVID Images: CDC CDC = Centers for Disease Control; COVID-19 = coronavirus 2019. CDC website. How to Protect Yourself & Others. Accessed October 22, 2020.
Health in the COVID Era
Myeloma and Treatments Both Contribute to How You Feel
Constellation of Symptoms
Myeloma cells in excess can cause symptoms
Treatments for myeloma kill myeloma cells but can cause symptoms
• Calcium elevation
• Fatigue
• Myelosuppression
• Renal dysfunction
• Infection
• Peripheral neuropathy
• Anemia
• Other symptoms
• Fatigue
• Bone pain
• Diarrhea
• Deep vein thrombosis • Infection (eg, shingles) • Other symptoms
How You Feel 74
What Happens if Symptoms Are Not Managed Effectively? Poorly managed symptoms can lead to... • Anxiety • Depression • Social isolation • Missed doses • Reduced treatment efficacy • Reduced quality of life
Constellation of Symptoms
Discuss how you feel with your team... • Keep a symptom diary; discuss with team • Many options but your team cannot help if they don’t know • Express your priorities – Fatigue is common concern but making the right treatment decision is higher priority for most
Faiman, B. CJON. 2017, 21(5)suppl 3-6. Faiman, B. et al 2017. Patient Reported Symptoms, Concerns and Provider Intervention in Patients with Multiple Myeloma
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Steroid Side Effects and Management Steroid Side Effects • Irritability,
mood swings, depression
• Difficulty sleeping
(insomnia), fatigue
• Increased risk of
infections, heart disease • Muscle weakness, cramping
• Blurred vision, cataracts • Flushing/sweating • Stomach bloating,
hiccups, heartburn, ulcers, or gas
• Weight gain, hair
thinning/loss, skin rashes
• Increase in blood
sugar levels, diabetes
Constellation of Symptoms
Managing Steroid Side Effects • Consistent schedule (AM vs. PM) • Take with food • Stomach discomfort: Over-the-counter or prescription medications • Medications to prevent shingles, thrush, or other infections
Steroids help kill myeloma cells. Do not stop or adjust steroid doses without discussing it with your health care provider.
• Increase in blood pressure,
water retention
King T, Faiman B. CJON. 2017; 21(5)suppl:240-249. Faiman B, et al. CJON. 2008;12(3)suppl:53-63.
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Fatigue, Depression, and Anxiety
Constellation of Symptoms
• All can effect quality of life and relationships • Sources include anemia, pain, reduced activity, insomnia, treatment toxicity, bone marrow suppression
Management
• Exercise (walking, yoga, etc) • Proper rest • Support (social network, support group, professional counseling, etc) • Prayer, meditation, spiritual support • Mindfulness-based stress reduction
• • • • •
Medications Massage, aroma therapy Supplements: ginseng Transfusion, if indicated Effective management of other symptoms
At least 70% of patients experience fatigue, but only 20% tell their provider. Let your provider know about symptoms that are not well controlled or thoughts of self harm. Catamero D et al. CJON. 2017; 21(5)suppl:7-18. Faiman, B. et al 2017. Patient Reported Symptoms, Concerns and Provider Intervention in Patients with Multiple Myeloma.
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Infection Prevention & Treatment • Compromised immune function comes from multiple myeloma and from treatment • Good personal hygiene (skin, oral) • Environmental control (wash hands, avoid crowds and sick people, etc) • Growth factor (Neupogen [filgrastim]) • Immunizations (NO live vaccines) • Medications (antibacterial, antiviral)
Constellation of Symptoms
Report fever of more than 100.4°F, shaking chills even without fever, dizziness, shortness of breath, low blood pressure to HCP as directed. Infection is serious for myeloma patients!
– New research: for patients receiving active myeloma therapy, levofloxacin 500 mg once daily for 12 weeks reduced infection (fevers, death) (ASH 2017 #903)
Brigle K, et al. CJON. 2017; 21(5)suppl:60-76.
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Pain Prevention and Management
Constellation of Symptoms
• Pain can significantly compromise quality of life • Sources of pain include bone disease, neuropathy and medical procedures • Management – Prevent pain when possible • Bone strengtheners to decrease fracture risk; antiviral to prevent shingles; sedation before procedures – Intervention depends on source of pain – May include medications, activity, surgical intervention, radiation therapy, etc – Complementary and alternative medicine (supplements, acupuncture, etc)
Tell your health care provider about any new bone pain or chronic pain that is not adequately controlled
Faiman B, et al. CJON. 2017;21(5)suppl:19-36.
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Knowledge is Power You are not alone - IMF has many resources to help you
Website: http://myeloma.org
eNewsletter: Myeloma Minute
Download or order at myeloma.org
Videos
IMF TV Teleconferences
Audience Q&A with Panel
Type and submit your questions here. Click the Q&A icon circled below if you have minimized the Ask Question window.
81
Workshop Video Replay & Slides As follow up to today's workshop, we will have the speaker slides and a video replay available. These will be provided to you shortly after the workshop concludes.
82
We want to hear from you! Feedback Survey Please take a moment to complete the survey. It will also be emailed to you shortly after the workshop.
Survey Click Here to complete the feedback survey
83
Thank you to our sponsors!
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