Multiple Myeloma | Cancer of the Bone Marrow
Understanding
XPOVIO
®
(selinexor)
February 2024 Edition A publication of the International Myeloma Foundation
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 nearly 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 quality of life of myeloma patients while working toward prevention and a cure. Call us at 1.818.487.7455 or 1.800.452.CURE, or visit myeloma.org.
Contents
You are not alone
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What you will learn from this booklet
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How Xpovio works
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How Xpovio is administered
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Xpovio indications, dose, and schedule
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Xpovio in clinical practice in 2024
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Warnings and precautions
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Possible side effects of Xpovio and how they are managed
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Patient access and support services for Xpovio
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In closing
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Terms and definitions
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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 Xpovio® (also known as selinexor, its generic drug name). Xpovio is approved by the U.S. Food and Drug Administration (FDA) for the treatment of adult patients with myeloma who have received at least 1 prior therapy. Xpovio is used in myeloma in both early relapse and late relapse settings. 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 publications.myeloma.org. 4
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How Xpovio works
Xpovio is a selective inhibitor of nuclear export (SINE) compound, the first medication in this drug class that has been approved by the FDA to treat myeloma. Xpovio prevents myeloma cells from expelling tumor suppressor proteins that help protect the cell from cancer. The forced nuclear retention of these proteins can counteract the pathways that allow cancer cells to continue to grow and divide.
How Xpovio is administered
Xpovio is an oral medication taken by mouth in the form of a tablet. Swallow the tablet whole with water. Do not break, chew, crush, or divide the tablets. Each Xpovio tablet should be taken at approximately the same time of day. Your doctor will monitor your complete blood count (CBC) and body weight before you start Xpovio and as needed during treatment. Your doctor will prescribe medication for nausea and vomiting to be taken before and during treatment with Xpovio. It is important that you take this medication as prescribed by your doctor, even if you’re not experiencing any nausea or vomiting. If you have any questions or concerns about your prescribed medication, discuss this with your doctor. Throughout your treatment with Xpovio, it is very important to maintain good intake of food and fluids. This topic is addressed later in this booklet. If necessary, you may receive intravenous (IV) fluids to prevent or treat dehydration.
Xpovio indications, dose, and schedule
In 2019, Xpovio was granted accelerated approval by the FDA for use in combination with the steroid dexamethasone [Xd] for the treatment of adult patients with relapsed and/or refractory myeloma who have received at least 4 prior therapies and whose disease is refractory to at least 2 proteasome inhibitors, at least 2 immunomodulatory agents, and an anti-CD38 monoclonal antibody. The approval of the Xd regimen was based on data from Part 2 of the STORM phase IIb clinical trial. In 2020, the FDA approved Xpovio in combination with Velcade® (bortezomib) + dexamethasone [XVd] for myeloma patients who have received at least 1 prior therapy. The approval of the XVd regimen was based on data from the BOSTON phase III randomized clinical trial. Based on the FDA approvals, Xpovio was initially used as part of the Xd protocol on a twice-weekly schedule (starting with a dose of 80 mg) or as part of the XVd protocol on a once-weekly schedule (starting with a dose of 100 mg). myeloma.org
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Xpovio in clinical practice in 2024
Based on data from the STORM, BOSTON, and STOMP clinical trials with Xpovio, the National Comprehensive Cancer Network (NCCN) Guidelines for myeloma list the following treatment options: ¡ Recommended for early relapse X Vd once-weekly after 1–3 prior therapies ¡ Useful in certain circumstances (based on the STOMP clinical trial) Kyprolis® (carfilzomib) + Xd [XKd] once-weekly after 1 or more prior lines of treatment, with Xpovio dosing starting at 80 mg and Kyprolis dosing at 56 mg/m2 Pomalyst® (pomalidomide) + Xd [XPd] once-weekly after 2 or more prior lines of treatment, with Xpovio dosing starting at 60 mg and Pomalyst dosing at 4 mg Darzalex® (daratumumab) + Xd [known as XDd, DXd, or Dara-Xd] once-weekly after 3 or more prior lines of treatment, with Xpovio dosing starting at 100 mg and Darzalex dosing at 16 mg/kg ¡ For late relapse after 4 or more prior therapies Xd twice-weekly, with Xpovio dosing starting at 80 mg Your doctor may opt to start you on Xpovio at a dose as low as 40 mg, and may recommend one or more additional dose modifications.
Warnings and precautions Neurological toxicity
In the BOSTON clinical trial, 26% of patients with myeloma who received Xpovio 100 mg once weekly experienced neurological adverse reactions (excluding peripheral neuropathy) that included dizziness, fainting, depressed level of consciousness, vertigo, amnesia, and mental status changes (including delirium and confusion). Severe Grade 3 or Grade 4 events occurred in 3.6% of patients. The median time to the first event was 29 days. Discontinuation due to neurological adverse reactions occurred in 2.1% of patients. In the STORM clinical trial, 30% of patients with myeloma who received Xpovio 80 mg twice weekly experienced neurological adverse reactions, including dizziness, fainting, depressed level of consciousness, and mental status changes (including delirium and confusion). Severe events (Grade 3–4) occurred in 9% of patients. The median time to the first event was 15 days.
Cataracts In the BOSTON clinical trial, the incidence of new onset of or worsening cataracts requiring clinical intervention was reported in 22% of patients with myeloma during treatment with Xpovio 100 mg. The median time to new onset of cataracts was 228 days and was 237 days for worsening of 6
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cataracts in patients presenting with cataracts at start of Xpovio therapy. Treatment of cataracts usually requires surgical removal of the cataract.
Embryo-fetal toxicity Xpovio can cause fetal harm, based on its mechanism of action as well as on data from animal studies. Females of reproductive potential and males with a female partner of reproductive potential must use effective contraception during treatment with Xpovio and for 1 week after the last dose. Do not use Xpovio if you are pregnant. Contact your doctor promptly if you become pregnant or if pregnancy is suspected during treatment with Xpovio.
Lactation There is no information about the presence of Xpovio in human milk, or its effects on the breastfed child or milk production. Because of the potential for serious adverse reactions in a breastfed child, women should not breastfeed during treatment with Xpovio and for 1 week after the last dose.
Infertility Based on findings in animals, Xpovio may harm fertility in males and females of reproductive potential.
Possible side effects of Xpovio and how they are managed
Good communication with your doctor is extremely important while you are receiving treatment for myeloma. If you experience any side effects, alert your doctor as soon as possible. Your side effects may be managed with supportive care, dose reductions, or dose interruptions. It is always better to deal with a problem immediately than to let it get worse. In the STORM phase IIb clinical trial of Xd, side effects that occurred in 20% or more of the study patients were thrombocytopenia, fatigue, nausea, anemia, decreased appetite, diarrhea, vomiting, hyponatremia, neutropenia, leukopenia, constipation, dyspnea, and upper respiratory tract infection. In the BOSTON phase III clinical trial of XVd, the most frequent Grade 3 or Grade 4 side effects were thrombocytopenia (39% in the XVd group vs. 17% in the Vd group), fatigue (13% vs. 1%), anemia (16% vs. 10%), and pneumonia (11% in both study arms).
Thrombocytopenia Thrombocytopenia is a low number of platelets in the blood. Platelets help blood to clot; fewer platelets can lead to easier bruising, bleeding, and slower healing. The “normal” level varies from laboratory to laboratory. For example, at Mayo Clinic the “normal” level is ≥ 150,000 platelets per microliter of circulating blood. If the platelet count is less than 50,000, myeloma.org
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bleeding problems could occur. Major bleeding is usually associated with a reduction to less than 10,000. Xpovio may cause thrombocytopenia.
Prevention and treatment of thrombocytopenia Your doctor will monitor your platelet counts at baseline and during treat ment, especially during the first two months. Management of low platelet counts may include interruption, reduction, or permanent discontinuation of your dose of Xpovio; platelet transfusions; or medication to stimulate the production of platelets.
Nausea or vomiting In the STORM phase IIb clinical trial, 72% of the 202 study participants experienced nausea (9% of the cases were severe), and the median time to the onset of the first episode of nausea was 3 days after starting Xpovio. Vomiting was reported in 41% of patients (4% of the cases were severe), and the median time to onset of first vomiting was 5 days after starting Xpovio.
Prevention and treatment of nausea and vomiting Your doctor will prescribe a required anti-nausea medication along with your prescription for Xpovio. Even if you’re not experiencing nausea, it is very important to start taking your anti-nausea medication as a preventive prior to treatment with Xpovio. Continue taking the anti-nausea medication as directed during treatment with Xpovio, even if you are not experiencing nausea. Your doctor may also manage your nausea by delaying, reducing, or stopping your treatment with Xpovio, and may also administer intravenous fluids to replace electrolytes and prevent dehydration.
Fatigue Fatigue is commonly associated with cancer and with cancer therapy. Fatigue that is related to cancer and its treatments is different from and more severe than normal fatigue, tends to last longer, and includes the feeling of overall weakness (the medical term for this is asthenia). For more information about this debilitating side effect, read the IMF’s publication Understanding Fatigue.
Prevention and treatment of fatigue Let your medical team know if you are experiencing fatigue. Your doctor may prescribe a medication to help minimize your fatigue. The effects of fatigue may also be minimized by maintaining the following: ¡ A moderate level of activity, ¡ A healthy diet and proper fluid intake, ¡ A consistent sleeping schedule, 8
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¡ Regularly scheduled visits with your doctor to monitor your red blood cell count (low red blood cells, or anemia, can cause fatigue) and to discuss issues that may be contributing to your fatigue, ¡ A careful review of the side effects of any other medications you are taking to ensure that they are not contributing to your fatigue.
Anemia Red blood cells contain hemoglobin, a protein that carries oxygen to the body’s tissues and organs. Anemia is usually defined as a decrease in hemoglobin < 10 g/dL or as a decrease of ≥ 2 g/dL from the normal level for an individual. More than 13–14 g/dL is considered normal. Low levels of oxygen in the body may cause shortness of breath and feelings of exhaustion.
Prevention and treatment of anemia Your doctor will determine which treatment regimen for anemia is best suited to and safest for you. Treatment of anemia may include the following: ¡ Interruption, reduction, or discontinuation of your dose of Xpovio, ¡ Blood transfusions, ¡ Erythropoietic (red blood cell-making) medication.
Decreased appetite In the STORM phase IIb clinical trial, 53% of the study participants experienced decreased appetite (5% of the cases were severe).
Prevention and treatment of decreased appetite Your doctor will give you a prescription for anti-nausea medication to help prevent loss of appetite and may also manage this side effect by interrupting and/or modifying the dose and schedule of Xpovio. You may be asked to weigh yourself daily and report the results to your doctor in order to monitor your condition closely. A publication by the National Cancer Institute (NCI), Eating Hints: Before, during, and after Cancer Treatment, may offer helpful hints for maintaining adequate nutrition.
Diarrhea Diarrhea is defined as 3 or more loose stools per day. Severe diarrhea is defined as 7 or more loose stools per day, requiring treatment with intravenous fluids or hospitalization.
Prevention and treatment of diarrhea Your doctor will modify your dose of Xpovio and/or use standard antidiarrheal medications such as Imodium® (loperamide HCl) to help control myeloma.org
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diarrhea. Dizziness, light-headedness, or fainting may occur due to dehydration caused by excessive or persistent diarrhea. If you become dehydrated, your doctor may order intravenous fluids for you.
Hyponatremia Sodium is an electrolyte, one of the minerals in the blood and other body fluids that carries an electrical charge and is essential for life. Sodium helps to regulate the amount of water that is in and around the cells, the acidity (pH) of the blood, nerve and muscle function (including the heart), and other important body processes. Vomiting and diarrhea can lead to reduced concentrations of sodium in the blood.
Prevention and treatment of hyponatremia Your doctor will monitor your levels of sodium before and during the first two months of your treatment with Xpovio. Your doctor will review your diet and may treat you with an IV saline solution or with salt tablets, or might make other recommendations. Your dose of Xpovio may be interrupted, reduced, or discontinued depending upon the severity of the hyponatremia.
Neutropenia Neutropenia is a reduced level of neutrophils, a type of white blood cell necessary in fighting 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. Fever caused by neutropenia is called febrile neutropenia.
Prevention and treatment of neutropenia Your doctor will assess your baseline neutrophil count before you start treatment with Xpovio. You will be monitored closely during the first two months of treatment, including for signs and symptoms of infection. Contact your doctor immediately if you have a fever, and make sure you have an emergency or after-hours number to reach a doctor if yours is not available. You may be given antimicrobial therapy if you are showing signs of infection. Your doctor may also prescribe a granulocyte colonystimulating factor (CSF) to increase production of your white blood cells. Your dose of Xpovio may be interrupted, reduced, or discontinued based on the severity of your neutropenia.
Constipation The medical definition of constipation is 3 or fewer bowel movements in one week. The stool may be hard, dry, and difficult to pass. You may also have stomach cramps and bloating. Not eating, not drinking enough water, and being less active can contribute to this problem. 10
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Prevention and treatment of constipation ¡ Drink sufficient fluids. ¡ Try to eat high-fiber foods. ¡ Try to be active every day, even if you exercise in a chair. Moving your body increases the rhythmic contractions that move food through your intestines. ¡ Report your constipation to your doctor or nurse.
Infections In the STORM phase IIb clinical trial, 52% of study participants experienced an infection. Upper respiratory tract infection occurred in 21% of the patients, pneumonia in 13%, and sepsis, the body’s potentially life-threatening response to an infection, occurred in 6% of patients. Severe infections were reported in 25% of patients, and deaths resulting from an infection occurred in 4% of patients. Most infections were not associated with a low neutrophil count. Tell your doctor immediately if you have any signs and symptoms of infection, including: ¡ Fever, ¡ Flu-like symptoms (body aches, sweating, chills), ¡ Sore throat, ¡ Cough (which may produce phlegm), ¡ Shortness of breath, ¡ Chest pain when you breathe or cough.
Prevention and treatment of infections You must report your symptoms to your doctor, who will determine how the symptoms should be managed and if you need to receive an antibiotic or other medications. If your doctor or another doctor covering the practice is not available, you should go to an urgent care or emergency facility.
Patient access and support services for Xpovio Karyopharm Therapeutics, the company that developed Xpovio has estab lished a patient support and resource center called KaryForward. You can enroll to receive help with access to Xpovio, learn about financial resources that may be available to you, and speak with a nurse case manager at a specialty pharmacy to ask questions about Xpovio or to discuss side effects. Contact KaryForward at karyforward.com or 1.877.527.9493. myeloma.org
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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. Asthenia: A condition in which the body lacks or has lost strength either as a whole or in any of its parts. Baseline: The initial known data that is gathered and used for comparison with later data. 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. Colony-stimulating factor (CSF): Proteins that stimulate the development and growth of blood cells. Neupogen® (filgrastim), Neulasta® (pegfilgrastim), and Leukine® (sargramostim) are colony-stimulating factors that are used to mobilize stem cells from the bone marrow into the bloodstream prior to apheresis. These may also be used after the transplant to hasten blood count recovery, or to treat low white cell count caused by therapy. 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. Dehydration: Excessive loss of water from the body. Symptoms and signs include thirst, dry mouth, weakness or lightheadedness (particularly if worse on standing up), dark urine, and a decrease in urination. Heat exposure, prolonged vigorous exercise, kidney disease, vomiting or diarrhea, as well as certain medications may lead to dehydration. 12
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Drug class: A group of medications that have a similar chemical structure or a similar mechanism of action (MoA). Dyspnea: The medical term for shortness of breath, often described as an intense tightening in the chest, air hunger, difficulty breathing, or breathlessness. Dyspnea can be caused by a host of medical problems, including anemia, pneumonia, or a pulmonary embolism. Electrolytes: Minerals in your blood and other body fluids that carry an electrical charge and are essential for life. Electrolytes include sodium, potassium, calcium, magnesium, chloride, phosphate, and bicarbonate. They affect the amount of water in the body, the acidity of the blood (pH), nerve and muscle function (including the heart), and other important processes. 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.” 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. Hyponatremia: A low level of sodium in the blood. Symptoms include nausea, headache, confusion, and fatigue. Hyponatremia can be caused by fluid loss through vomiting or diarrhea, and also by fluid overload from heart, liver, or kidney disease. 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®).” Intravenous (IV) infusion: Administered into a vein. Leukopenia: A low number of white blood cells. 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. myeloma.org
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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. 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. Side effect: An unwanted or unexpected effect caused by a drug. Also known as adverse reaction or adverse event (AE). Steroid: A type of hormone. Steroidal hormones are produced by the body. Synthetic analogues (equivalents) of some steroids can be manufactured in a laboratory. Dexamethasone, prednisone, and methylprednisolone are synthetic steroids that have multiple effects and are used for many conditions, including myeloma. 14
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Connect. Be Informed. Take Charge. 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
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