With Myeloma, Even a 20-year Survivor Always Has More to Learn

Yelak Biru |

Anytime you can reduce dexamethasone (dex), do it 

There was one specific trial that was presented at this year’s ASH that studied the benefit of dex. The study was conducted with 199 intermediate fit patients with Revlimid and dexamethasone (Rd) induction (9 cycles) and Revlimid (R) maintenance until progression compared to Rd induction and Rd maintenance until progressions. The study found that there was no benefit in continuing with the dex for these newly diagnosed elderly patients as it related to overall survival. Given that, the multiple myeloma key opinion leaders are saying, “This is immediate treatment-changing.”

There seems to also be another trial in profess composing pomalidome+Dex with just Pom.

Anytime you can participate in clinical trials, do it.

There were dozens of  new immunotherapies, combination of existing novel therapies in triplet and quadruplet, and other novel therapies that were presented at this years ASH.

Daratumumab took center stage as part of  quadruplet regime with a proteasome inhibitor, immunomodulatory drug (IMiD), and dex –

Dara plus ixazomib, Revlimid, and dex

In both cases the investigators reported rapid, deep and sustained response to these combinations. Both regimens also reported sustained response and indicated to go to phase III clinical trials,

There were clinical trial results showing benefits for oral selinexor for patients that were refractory to multiple lines of previous therapies. Multiple studies are in progress with various combinations. The major toxicity/side effect was gastrointestinal.

I even learned about a possible, promising new drug for multiple myeloma: Melflufrn. Dr. Paul Richardson discussed the mechanism of action for this drug and the rational for its development. I’m am. I am ashamed to say it all went above my head. But, in case you’re interested here is a description slide from him.


There was also another drug that I haven’t heard before, Atezolizumab. The study was designed in combination with Dara and showed promising result.

There were several studies that were presented using immunotherapies. One of the presented studies was using a BCMA targeting CAR-T. What was unique about this drug was that it was administered using a carry-on pump and is administered over a period of four weeks. That was not a mistype. The drug is administered in a 4-weeks on and 2-weeks off pattern. The investigators reported promising results.



One of the BCMA based drugs in study was AMG 420. The interesting, and may be concerning, as it relates to quality of life, is that AMG420 is administered over a period of 4 weeks continuous infusion.

It’s best for someone not to be diagnosed with multiple myeloma. But, if one has to be diagnosed, this is the best time to be.


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