IMF Special Educational Session
What a Newly Diagnosed Patient Needs to Know Dr. Brian G.M. Durie Cedars-Sinai Outpatient Cancer Center
IMF Webinar Primer for Newly Diagnosed Patients & Caregivers April 30, 2021 9:00AM PT/ 11:00AM CT/ 12:00PM ET
Meeting Housekeeping Zoom Control Bar –
Technical Issues – Chat “IMF Tech. – Jon Fitzpatrick Audio & Video – Audio - Please stay muted unless asking a question. Our Admin Team will mute individuals as needed to prevent audio feedback.
Video - When asking a question, we’d love to see you! 1
Meeting Housekeeping Questions – “Chat” Box - Please feel free to put questions in the “Chat” box through out the meeting.
“Raise Hand” – During the Q&A portion of the meeting, please raise your hand to verbally ask a question.
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Myeloma is treatable Over 90% of patients respond to current therapies Average first remission is 4 years or more In 2021, average survival is at least 7-10 years Some patients live over 15-20+ years New therapies are constantly improving the outlook 3
Myeloma Expert Consultation Helps! Good to do early! Virtual consults more available. Sets path for future Guides local doctor
SEE: Questions to ask your doctor https://www.myeloma.org/resource-library/tip-card-ask-your-doctor-these-important-questions
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Careful testing required for diagnosis and monitoring Bone marrow indicates % myeloma X-rays/ scans show where lesions* are located X-ray image of myeloma lesions in arm
Myeloma cells as seen in a bone marrow aspirate
See further discussion: “What is a lesion?” https://www.myeloma.org/bone-disease
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Careful testing required for diagnosis and monitoring Blood tests show: blood counts; SPEP
myeloma protein level (SPEP; IFE; Freelite) plus •
calcium
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kidney function and
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liver function levels
IgG
Spike
Urine tests can show myeloma protein level (UPEP) and evidence of kidney damage
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Other Things to Know Myeloma is generally not hereditary (only rare families)
Myeloma types: IgG/ IgA/ IgD/ IgE (IgM usually Waldenström macroglobulinemia) Baseline staging important/helpful See further discussion – “Types of myeloma” https://www.myeloma.org/types-of-myeloma
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IMWG diagnostic criteria for multiple myeloma (Myeloma Defining Events)
*CRAB Criteria C R A B
https://www.myeloma.org/resource-library/international-myeloma-working-group-consensus-criteria-response-minimal-residual
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More Test Details Bone marrow FiSH shows chromosome results MRI and PET/CT show more lesions than x-rays FISH
PET
MRI
PET FiSH – Fluorescent in Situ Hybridization
F = Focal D = Diffuse
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More Test Details Blood tests Tracking SPEP/IFE and blood counts essential to assess impact of treatment Urine tests Also required for tracking + Freelite, a serum test for light chains
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Key Terminology RESPONSE Occurs within 1-2 months
* Remission if 50% reduction sustained
Measured by myeloma protein level “Response*” 50% reduction = [Partial Response (PR)] VGPR 75% reduction = Very Good PR CR 100% reduction = Complete Response stringent CR = sCR (Freelite normal and [BM mPCs] Bone Marrow myeloma Plasma Cells < 5%)
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Key Terminology DEEP RESPONSE Minimal Residual Disease (MRD) Specialized testing of bone marrow negative at different levels: 10-4; 10-5; 10-6
(zero out of million)
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Key Terminology RESPONSE Remission = response sustained with follow-up testing Length of remission = “Progression Free Survival” (PFS) This is time during which the myeloma protein level does not go back up by 25% or more which is PD – Progressive Disease or Relapse (“biochemical” if no symptoms) 13
Key Terminology RESPONSE Overall survival (OS) is calculated from first day of myeloma treatment Progression free survival (PFS)
41 months
Overall survival (OS) 80% = 4 years 55% = 7 years
SWOG S0777: Lenalidomide and Dexamethasone With or Without Bortezomib in Treating Patients With Previously Untreated Multiple Myeloma
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What to Expect with Treatment First “biochemical” relapse
100% Deep first response
Myeloma protein level 50%
MRD Undetected
Second response
Later relapse from MRD undetected
Possible MRD undetected
5 years
10 years 15
Treatment Options “Triple therapy”: 3 drugs recommended •
Most common = VRd* [Rd for older/frail]
(Velcade®/ Revlimid®/ dexamethasone) ASCT (Autologous Stem Cell Transplant) Can be considered to achieve better response (after 3-6 months of VRd) Plus
Zometa®/ Aredia or denosumab for bone lesions
* Other options include VCd (CyBorD); KRd; Dara + Rd; Vd 16
Treatment Options Maintenance: used to sustain remission •
Most common = Revlimid® ± Velcade®/ Ninlaro® (ixazomib)
Articles for Reference Durie B, et al. Blood Cancer Journal 2020 May 11;10(5):53. Longer term follow-up of the randomized phase III trial SWOG S0777: bortezomib, lenalidomide and dexamethasone vs. lenalidomide and dexamethasone in patients (Pts) with previously untreated multiple myeloma without an intent for immediate autologous stem cell transplant (ASCT) https://www.nature.com/articles/s41408-020-0311-8 Usmani S, et al. Blood Cancer Journal 2018 Nov 23;8(12):123. Clinical predictors of long-term survival in newly diagnosed transplant eligible multiple myeloma - an IMWG Research Project https://www.nature.com/articles/s41408-018-0155-7 Kumar S, et al. Leukemia. 2019; 33(7): 1736–1746. Ixazomib, lenalidomide, and dexamethasone in patients with newly diagnosed multiple myeloma: long-term follow-up including ixazomib maintenance https://www.nature.com/articles/s41375-019-0384-1
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Caregivers Need Care Too!
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IMF Website – http://www.myeloma.org http://www.myeloma.org
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Ask your questions for Dr. Durie Type your questions and press Submit.
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