Founded in 1990, the International Myeloma Foundation (IMF) is the first and largest organization focusing specifically on myeloma. The IMF’s reach extends to more than 525,000 members in 140 countries. The IMF is dedicated to improving the quality of life of myeloma patients while working toward prevention and a cure through our four founding principles: Research, Education, Support, and Advocacy.
RESEARCH The IMF is dedicated to finding a cure for myeloma, and we have a range of initiatives to make this happen. The International Myeloma Working Group, which emerged from the IMF’s Scientific Advisory Board established in 1995, is the most prestigious organization with more than 300 myeloma researchers conducting collaborative research to improve outcomes for patients while providing critically appraised consensus guidelines that are followed around the world. Our Black Swan Research Initiative® is bridging the gap from long-term remission to cure. Our annual Brian D. Novis Research Grant Program is supporting the most promising projects by junior and senior investigators. Our Nurse Leadership Board, comprised of nurses from leading myeloma treatment centers, develops recommendations for the nursing care of myeloma patients.
EDUCATION The IMF’s webinars, seminars, and workshops provide up-to-date information presented by leading myeloma scientists and clinicians directly to patients and their families. We have a library of more than 100 publications for patients, care partners, and healthcare professionals. IMF publications are always free-of-charge, and available in English and select other languages.
SUPPORT The IMF InfoLine responds to your myeloma-related questions and concerns via phone and email, providing the most accurate information in a caring and compassionate manner. We also sustain a network of myeloma support groups, training hundreds of dedicated patients, care partners, and nurses who volunteer to lead these groups in their communities.
ADVOCACY We empower thousands of individuals who make a positive impact each year on issues critical to the myeloma community. In the U.S., we lead coalitions to represent the interests of the myeloma community at both federal and state levels. Outside the U.S., the IMF’s Global Myeloma Action Network works to help patients gain access to treatment. Learn more about the ways the IMF is helping to improve the
us at 1.818.487.7455 or 1.800.452.CURE, or visit myeloma.org .
You are not alone
The International Myeloma Foundation (IMF) is here to help you. The IMF is committed to providing information and support for patients with multiple myeloma (which we refer to simply as “myeloma”) and their care partners, friends, and family members.
We achieve this through a broad range of resources available on our website myeloma.org, and through numerous programs and services such as seminars, webinars, workshops, and the IMF InfoLine, which consistently provides the most up-to-date and accurate information about myeloma in a caring and compassionate manner. Contact the IMF InfoLine at 1.818.487.7455 or InfoLine@myeloma.org.
What you will learn from this booklet
Myeloma is a cancer that is not known to most patients at the time of diagnosis. To play an active role in your own medical care and to make good decisions about your care with your doctor, it is important and helpful to learn about myeloma, as well as its treatment options and supportive care measures.
The IMF’s Understanding-series publications address treatments for myeloma, supportive care measures, and the tests that are used to diagnose, monitor, and assess disease status throughout its course.
This booklet discusses Tecvayli® (also known as teclistamab-cqyv, its generic drug name), the first in a drug class of bispecific antibodies approved by the U.S. Food and Drug Administration (FDA) to treat myeloma.
If you are newly diagnosed with myeloma, we suggest that you read the IMF’s publication Patient Handbook for the Newly Diagnosed, which will help you to better understand this complex disease.
To learn about myeloma in later disease settings, read the IMF’s publication Concise Review of Relapsed and Refractory Myeloma.
Words in bold+blue type are explained in the “Terms and definitions” section at the end of this booklet. A more comprehensive glossary can be found in the IMF’s publication Understanding Myeloma Vocabulary located online at glossary.myeloma.org.
If you are reading this booklet in electronic format, the light blue links will take you to the corresponding resources. All IMF publications are free-of-charge and can be downloaded or requested in printed format at publications.myeloma.org.
How Tecvayli works
Tecvayli is an immunotherapy that enhances a patient’s own immune system to attack their myeloma cells. Tecvayli is a bispecific antibody (also called “bispecific therapy”), a laboratory-made monoclonal antibody that binds to two (“bi”) targeted cells.
Tecvayli has two “arms.” One arm binds to the myeloma cell surface by adhering to the B-cell maturation antigen (BCMA). The other arm binds to a local T cell by its CD3 antigen. Tecvayli brings the myeloma cell and the T cell together and activates the T cell to release cytotoxic granules to destroy the myeloma cell.
A similar strategy is already used in myeloma. Chimeric antigen receptor (CAR) T-cell therapy involves collecting the patient’s T cells, engineering them in a laboratory to express a receptor that can attach to BCMA on the surface of a myeloma cell, multiplying the engineered T cells in a laboratory, then re-infusing them into the patient to attack their myeloma.
Tecvayli differs from CAR T-cell therapy in that there is no need to collect the patient’s T cells. Instead, Tecvayli engages the patient’s T cells directly after injection. Not having to collect, engineer, and manufacture T cells over the course of several weeks shortens the time-to-treatment for the myeloma patient. The “off-the-shelf” availability of Tecvayli makes it easier to access treatment.
Indications for treatment with Tecvayli
Tecvayli is FDA-approved for adult patients with relapsed or refractory multiple myeloma (RRMM) who have received at least 4 prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent , and an anti-CD38 monoclonal antibody.
Clinical trial experience with Tecvayli
A clinical trial is a medical research study with people who volunteer to test scientific approaches to a new treatment or a new combination therapy. Each clinical trial is designed to find better ways to prevent, detect, diagnose, or treat cancer and to answer scientific questions.
The safety of Tecvayli was evaluated in the MajesTEC-1 clinical trial with adult patients with RRMM. Patients received step-up doses of 0.06 mg/kg and 0.3 mg/kg of Tecvayli followed by 1.5 mg/kg of Tecvayli, given by a subcutaneous (SQ) injection once-weekly. The median age of patients who received Tecvayli was 64 years (range of 33 to 84 years); 58% were male; 81% were white, 13% were Black, and 2% were Asian.
The MajesTEC-3 clinical trial of patients with RRMM is studying Tecvayli in combination with Darzalex® (daratumumab) vs. Darzalex + Pomalyst® (pomalidomide) + dexamethasone [DPd] or Darzalex + Velcade® (bortezomib) + dexamethasone [DVd].
Tecvayli is also being studied in several other clinical trials as part of different combination therapies, at different doses, and in earlier disease settings.
a. See Table 2 for recommendations on restarting Tecvayli after dose delays.
b. Step-up dose 2 may be given between 2 to 4 days after step-up dose 1 and may be given up to 7 days after step-up dose 1 to allow for resolution of side effects.
c. First treatment dose may be given between 2 to 4 days after step-up dose 2 and may be given up to 7 days after step-up dose 2 to allow for resolution of side effects.
Tecvayli administration, dosing, and schedule
When Tecvayli is injected, there is a risk that the patient’s immune system may react in a way that causes a cytokine release syndrome (CRS), which is explained in the next section of this booklet. Therefore, Tecvayli is given at lower doses to begin with so it can be tolerated better by the patient’s immune system.
At the discretion of the treating doctor, the patient may be admitted to the hospital for 48 hours after the administration of each “step-up” dose of Tecvayli. Alternatively, the individual may be monitored on an outpatient basis for CRS and the risk of neurologic toxicity.
The recommended dosing schedule for Tecvayli is provided in Table 1. The two step-up doses of Tecvayli are 0.06 mg/kg then 0.3 mg/kg. The regular once-weekly treatment dose is 1.5 mg/kg given until disease progression or unacceptable side effects. Pretreatment medications are given prior to each dose of the Tecvayli step-up dosing schedule, which includes step-up dose 1, step-up dose 2, and the first treatment dose.
Warnings and precautions
The most common side effect occurring in 20% or more patients treated with Tecvayli in the MajesTEC-1 clinical trial are fever, CRS, musculoskeletal pain, injection site reaction, fatigue, upper respiratory tract infection, nausea, headache, pneumonia, and diarrhea.
Step-up dose 2
8 days to 28 days
Repeat step-up dose 2 (0.3 mg/kg)a and continue Tecvayli step-up dosing schedule. More than
daysb Restart Tecvayli step-up dosing schedule at step-up dose 1 (0.06 mg/kg).a
8
More than
Continue Tecvayli weekly dosing schedule at treatment (1.5 mg/kg).a
Restart Tecvayli step-up dosing schedule at step-up dose 1 (0.06 mg/kg).a
a. Pretreatment medications are given prior to Tecvayli dose and patients are monitored accordingly.
b. Discuss with your doctor the benefit-risk of restarting Tecvayli if you require a dose delay of more than 28 days due to a side effect.
The most common severe laboratory abnormalities occurring in 20% or more of patients treated with Tecvayli are decreased lymphocytes, decreased neutrophils, decreased white blood cells, decreased hemoglobin, and decreased platelets.
Tecvayli is available only through a Risk Evaluation and Mitigation Strategy (REMS) restricted program. The FDA requires a REMS program if a specific drug or treatment has serious safety concerns. REMS programs support the use of such drugs or treatments and help ensure that the potential benefits outweigh the risks.
Cytokine release syndrome (CRS)
Cytokines are proteins that are produced in the bone marrow and then circulate in the bloodstream, stimulating or inhibiting the growth and/or activity of other cells. CRS is a potentially fatal, uncontrolled immune reaction in which cytokines become highly elevated and trigger an overwhelming immune system response. A “cytokine storm” can seriously damage body tissues and organs.
In the MajesTEC-1 clinical trial, CRS occurred in 72% of patients who received Tecvayli at the recommended dose, with Grade 1 CRS occurring in 50% of patients, Grade 2 in 21%, and Grade 3 in 0.6%. Most patients experienced CRS following step-up dose 1, step-up dose 2, or the first treatment dose. After subsequent doses of Tecvayli, less than 3% of study participants developed CRS. The median time to onset of CRS was 2 days (range of 1 to 6 days) after the most recent dose, with a median duration of 2 days (range of 1 to 9 days). Clinical signs and symptoms of CRS included, but were not limited to, fever, hypoxia, chills, hypotension, sinus tachycardia, headache, and elevated liver enzymes.
Prevention and treatment of CRS
To reduce risk of CRS, therapy with Tecvayli should be started with the step-up dosing schedule. Pretreatment medications are given to reduce risk of CRS. Patients are monitored following administration of Tecvayli. At the first sign of CRS, immediate evaluation should be made to consider the patient for hospitalization. Supportive care is administered based on severity of CRS. Further management should follow current practice guidelines. Tecvayli administration may be interrupted or discontinued, depending on the severity of the CRS.
Neurologic toxicities
Immune effector cell-associated neurotoxicity syndrome (ICANS) has occurred in patients following treatment with Tecvayli. ICANS often correlates with CRS but it can also occur in the absence of CRS. After
treatment with Tecvayli, ICANS can occur before, during, or after CRS onset, or after CRS resolution. ICANS may be severe, life-threatening, or fatal. Symptoms of neurologic side effects include but are not limited to confusion, disorientation, loss of consciousness, seizures, tremor, slower movements, changes in personality, depression, tingling and numbness of hands and feet, leg and arm weakness, facial numbness, and difficulty speaking, reading, or writing.
In the MajesTEC-1 clinical trial, neurologic toxicity occurred in 57% of patients who received Tecvayli at the recommended dose, with Grade 3 or 4 neurologic toxicity occurring in 2.4% of patients. The most frequent neurologic toxicities were headache (25%), motor dysfunction (16%), sensory neuropathy (15%), and encephalopathy (13%). With longer follow-up of patients who received Tecvayli, Grade 4 seizure occurred in 1 patient and fatal Guillain-Barré syndrome (GBS) occurred in 1 patient.
ICANS was reported in 6% of patients who received Tecvayli at the recommended dose. Recurrent ICANS occurred in 1.8% of patients. Most patients experienced ICANS following step-up dose 1 (1.2%), step-up dose 2 (0.6%), or the initial treatment dose (1.8%). Less than 3% of patients developed first occurrence of ICANS following subsequent doses of Tecvayli. The median time to onset of ICANS was 4 days (range of 2 to 8 days) after the most recent dose with a median duration of 3 days (range of 1 to 20 days).
Prevention and treatment of neurologic toxicities
Patients must be monitored for signs and symptoms of neurologic toxicity during treatment with Tecvayli. At the first sign of neurologic toxicity, including ICANS, patients are provided supportive therapy based on severity, and Tecvayli treatment may also be withheld.
Patients are advised to refrain from driving or operating heavy or potentially dangerous machinery during and for 48 hours after completion of Tecvayli step-up dosing schedule and in the event of new onset of any neurologic toxicity symptoms until neurologic toxicity resolves.
Hepatotoxicity
Tecvayli can cause hepatotoxicity. Drug-induced hepatotoxicity is an injury to the liver or an impairment of the liver function caused by exposure to a specific compound.
In the MajesTEC-1 clinical trial, there was 1 fatal case of hepatic failure. Elevation of the liver enzyme aspartate aminotransferase (AST) occurred in 34% of patients, with Grade 3 or 4 elevations in 1.2%. Elevated alanine aminotransferase (ALT) occurred in 28% of patients, with Grade 3 or 4
elevations in 1.8%. Elevated total bilirubin occurred in 6% of patients with Grade 3 or 4 elevations in 0.6%. Liver enzyme elevation can occur with or without concurrent CRS.
Prevention and treatment of hepatotoxicity
Liver enzymes and bilirubin should be measured at baseline and during treatment as clinically indicated. Tecvayli may be withheld or discontinued based on severity.
Infections
Tecvayli can cause severe, life-threatening, or fatal infections. In patients who received Tecvayli at the recommended dose in the MajesTEC-1 clinical trial, serious infections occurred in 30% of patients, with Grade 3 or 4 infections in 35%, and fatal infections in 4.2%.
Prevention and treatment of infections
It is essential for your doctor to monitor you for signs and symptoms of infection prior to and during treatment with Tecvayli. It is also essential for you to promptly alert your doctor if you experience any infection. Based on the severity of your infection, your doctor may prescribe antibiotics and/or withhold or discontinue Tecvayli. Your immunoglobulin levels should be monitored to assess if you need intravenous immunoglobulin (IVIG) therapy.
Neutropenia
Neutropenia is a reduced level of neutrophils, a type of white blood cell necessary to combat bacterial infections. Having too few neutrophils can lead to infection. Fever is the most common sign of neutropenia. If you have a fever, you must get immediate medical attention.
Tecvayli can cause neutropenia and febrile neutropenia. In patients who received Tecvayli at the recommended dose in the MajesTEC-1 clinical trial, decreased neutrophils occurred in 84% of patients, with Grade 3 or 4 decreased neutrophils in 56%. Febrile neutropenia occurred in 3% of patients.
Prevention and treatment of neutropenia
Complete blood count (CBC) should be measured at baseline and periodically during treatment. Patients may need growth factors. Signs or symptoms of infections should be discussed with the healthcare team.
Hypersensitivity and other ARR
Tecvayli can cause both systemic and local administration-related reactions (ARR). In the MajesTEC-1 clinical trial, 1.2% of patients who received Tecvayli at the recommended dose experienced systemic ARR (including Grade 1 recurrent fever and Grade 1 swollen tongue), and 35% of patients experienced local ARR (with 30% Grade 1 and 4.8% Grade 2).
Prevention and treatment of hypersensitivity and other ARRs
Based on the severity of ARR, Tecvayli may be withheld or discontinued.
Embryo-fetal toxicity
Embryo-fetal toxicity is an exposure of an embryo or a fetus to a toxic substance. Females of reproductive potential and males with female partners of reproductive potential should ask the treating doctor if the use of effective contraception is necessary before treatment begins, during treatment, and/or after the last dose of treatment is administered.
In closing
This booklet is not meant to replace the advice of your doctors and nurses who are best able to answer questions about your specific healthcare management plan. The IMF intends only to provide you with information that will guide you in discussions with your healthcare team. To help ensure effective treatment with good quality of life, you must play an active role in your own medical care.
We encourage you to visit myeloma.org for more information about myeloma and to contact the IMF InfoLine with your myeloma-related questions and concerns. The IMF InfoLine consistently provides the most up-to-date and accurate information about myeloma in a caring and compassionate manner. Contact the IMF InfoLine at 1.818.487.7455 or InfoLine@myeloma.org.
Terms and definitions
The following selected terms are used in this booklet, while a more complete glossary can be found in the IMF’s publication Understanding Myeloma Vocabulary located online at glossary.myeloma.org.
Antigen: Any foreign substance that causes the immune system to produce natural antibodies. Examples of antigens include bacteria, viruses, parasites, fungi, and toxins.
B-cell maturation antigen (BCMA): A protein involved in myeloma cell growth and survival. BCMA is found on the surface of cells in all patients with myeloma. Also called “tumor necrosis factor receptor superfamily member 17 (TNFRSF17).”
Cancer: A term for diseases in which malignant cells divide without control. Cancer cells can invade nearby tissues and spread through the bloodstream and lymphatic system to other parts of the body.
Complete blood count (CBC): Many cases of MGUS, SMM, and myeloma are identified as the result of this routine blood test, which quantifies all the
cells that make up the solid parts of blood. The CBC is usually performed as part of an annual medical exam, and it is also one of the tests needed for diagnosing and monitoring patients with myeloma.
Disease progression: See “ Progressive disease.”
Drug class: A group of medications that have a similar chemical structure or a similar mechanism of action (MoA).
Encephalopathy: Any brain disease that alters brain function or structure. Causes may include infection, tumor, or stroke. Symptoms may include reduced ability to reason or concentrate, memory loss, personality change, twitching, or seizures.
Enzyme: A protein molecule manufactured by a cell. An enzyme acts as a catalyst that increases the rate of a specific biochemical reaction in the body. Febrile neutropenia: The development of fever, often with signs of infection, in a patient with neutropenia. Febrile neutropenia is usually treated with antibiotics even if an infectious source can’t be identified. See “ Neutropenia.”
Frontline therapy: A general term for the initial treatment used in an effort to achieve response in a newly diagnosed myeloma patient. See “ Induction therapy ” and “ Response or remission.”
Generic drug name: A brand name identifies a drug as property of the company that receives approval for it from a governmental regulatory agency, such as the U.S. Food and Drug Administration (FDA). After a drug goes “off patent,” other companies may make generic versions of the drug under a generic name that refers to the chemical makeup of a drug.
Grade: The toxicity criteria adopted in the United States by the National Cancer Institute (NCI) for cancer clinical trials includes:
• Grade 0 – no symptoms,
• Grade 1 – mild symptoms,
• Grade 2 – moderate symptoms,
• Grade 3 – symptoms requiring treatment,
• Grade 4 – symptoms requiring urgent intervention,
• Grade 5 – symptoms resulting in death.
Guillain-Barré syndrome (GBS): A rare neurological disorder in which the immune system mistakenly attacks part of the patient’s own network of nerves located outside of the brain and spinal cord. Cases of GBS can be mild (brief weakness) or severe (paralysis). Most patients eventually recover but some will continue to have a degree of weakness.
Hemoglobin: A protein in red blood cells that carries oxygen.
Hypoxia: A low level of oxygen in body tissues. Symptoms of hypoxia may include confusion, restlessness, difficulty breathing, rapid heart rate, and bluish skin.
Immune system: A complex network of cells, tissues, organs, and the substances they make. The immune system helps the body defend itself by destroying infected and diseased cells and removing cellular debris, while protecting healthy cells.
Immunomodulatory agent: A drug that can modify, enhance, or suppress the functioning of the immune system. An immunomodulatory agent is sometimes called an “immunomodulatory drug (IMiD®).”
Induction therapy: The initial treatment given to a patient in preparation for an autologous stem cell transplant (ASCT). See “ Frontline therapy ” and “ Line of therapy.”
Line of therapy: A term used to calculate the number of therapies a patient has received. A line of therapy is 1 or more complete cycles of a regimen that can consist of a single agent, a combination of several drugs, or a planned sequential therapy of various regimens. Also see “ Induction therapy.”
Lymphocytes: B cells (B lymphocytes), T cells (T lymphocytes), and natural killer (NK) cells that together constitute 30% of white blood cells (WBC).
Median: The mean (middle) of two central numbers in a series of numbers. For example, “median progression-free survival (mPFS)” means that half the patients had remissions that were shorter and half the patients had remissions that were longer than the mPFS.
Monoclonal antibody: An antibody manufactured in a lab rather than produced in the human body. Monoclonal antibodies are specifically designed to find and bind to cancer cells and/or immune system cells for diagnostic or treatment purposes. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to tumor cells.
Multiple myeloma: A cancer of the bone marrow plasma cells, white blood cells that make antibodies. Cancerous plasma cells are called myeloma cells.
Neutropenia: A reduced level of neutrophils, a type of white blood cell necessary to combat bacterial infection. Having too few neutrophils can lead to infection. Fever is the most common sign of neutropenia. If you have a fever, you must get immediate medical attention.
Platelets: One of the three major types of blood cells, the others being red blood cells and white blood cells. Platelets plug up breaks in the blood vessel walls and release substances that stimulate blood clot formation. Platelets are the major defense against bleeding. Also called thrombocytes.
Progressive disease: Myeloma that is becoming worse or relapsing, as documented by tests. Defined as an increase of ≥ 25% from the lowest confirmed response value in the myeloma protein level and/or new evidence of disease.
Proteasome: A joined group (“complex”) of enzymes (“proteases”) that break down the damaged or unwanted proteins in both normal cells and cancer cells into smaller components. Proteasomes also carry out the regulated breakdown of undamaged proteins in the cell, a process that is necessary for the control of many critical cellular functions. These smaller protein components are then used to create new proteins required by the cell. This is important for maintaining balance within the cell and for regulating cell growth.
Proteasome inhibitor: Any drug that interferes with the normal function of the proteasome. See “ Proteasome.”
Refractory: Disease that is no longer responsive to standard treatments. Myeloma is refractory in patients who have had progressive disease either during treatment or within 60 days following treatment. Most clinical trials for advanced disease are for patients with relapsed and/or refractory myeloma.
Relapse: The reappearance of signs and symptoms of myeloma after a period of improvement. Patients with relapsed disease have been treated, then developed signs and symptoms of myeloma at least 60 days after treatment ended. Most clinical trials for advanced myeloma are for patients with relapsed and/or refractory disease.
Response or remission: Interchangeable terms to describe the complete or partial disappearance of the signs and symptoms of cancer.
• Stringent complete response (sCR) – sCR is CR (as defined below) plus normal FLC ratio and absence of clonal cells in bone marrow by immunohistochemistry or immunofluorescence.
• Complete response (CR) – For myeloma, CR is negative immunofixation on serum (blood) and urine, and disappearance of any soft tissue plasmacytomas, and ≤ 5% plasma cells in bone marrow. CR is not the same as a cure.
• Very good partial response (VGPR) – VGPR is less than CR. VGPR is serum M-protein and urine M-protein detectable by immunofixation but not on electrophoresis, or 90% or greater reduction in serum M-protein, plus urine M-protein less than 100 mg per 24 hours.
• Partial response (PR) – PR is a level of response in which there is at least a 50% reduction in M-protein, and reduction in 24-hour urinary M-protein by at least 90% (or to less than 200 mg per 24 hours).
Side effect: An unwanted or unexpected effect caused by a drug. Also known as adverse reaction or adverse event (AE).
Subcutaneous (SQ) injection: A method of administering medication under the skin by a short needle that injects a drug into the tissue layer between skin and muscle.
T cell (T lymphocyte): A type of white blood cell that plays a central role in the immune system. T cells can be distinguished from other lymphocytes, such as B cells and natural killer (NK) cells, by the presence of a T-cell receptor (TCR) on the cell surface. They are called T cells because they mature in the thymus, although some also mature in the tonsils.
Tachycardia: A heart rate that is more than 100 beats a minute. Tachycardia may not cause any symptoms and may not be a concern, such as during exercise or as a response to stress. But some forms of tachycardia can lead to serious problems if left untreated, including heart failure, stroke, or sudden cardiac death.
INTERACTIVE RESOURCES AT A GLANCE
Use the hyperlinks and web addresses included in this publication for quick access to resources from the IMF.
infoline.myeloma.org
Contact the IMF InfoLine with your myeloma-related questions and concerns
medications.myeloma.org
Learn about FDA-approved therapies for myeloma
diversity.myeloma.org
Diversity and inclusion are integral aspects of the myeloma community
videos.myeloma.org
The latest on myeloma research and clinical practice, as well as IMF webinars and other events
support.myeloma.org
Robin Tuohy
rtuohy@myeloma.org will help you find a multiple myeloma support group
publications.myeloma.org
IMF booklets, tip cards, guides, and periodicals –subscribe to stay in the know!
Sign up at subscribe.myeloma.org for our quarterly journal Myeloma Today and weekly e-newsletter Myeloma Minute, as well as alerts about IMF news, events, and actions. And engage with us on social media!
/myeloma
@IMFMyeloma