What does it mean for multiple myeloma to become relapsed/refractory?

Transcription: Colleen Moretti: What is relapsed/refractory multiple myeloma? How is it different from common diseases?

dr usmani sad: Relapsed and/or refractory myeloma is myeloma that has relapsed after the patient received initial therapy at diagnosis. Usually, when a patient is diagnosed, he is given a combination of 3 or 4 drugs as part of the induction. Patients who are eligible for stem cell transplants proceed with stem cell transplantation. However, after induction and/or transplant reduce myeloma burden or disease burden, patients proceed to maintenance therapy. This is the typical first line approach.

And when myeloma comes back, it’s called recurrent myeloma. If a patient stops her treatment for more than 60 days and the myeloma recurs, or if the myeloma recurs after a period of time after stopping treatment for more than 60 days, it is called recurrent myeloma. . However, if the myeloma recurs during active treatment or within 60 days of stopping treatment for any reason, it is called relapsed/refractory multiple myeloma. Therefore, it really depends on where the patient is in their therapeutic journey and whether they are receiving active treatment. It’s important to be aware of these entities so that when it’s time for a patient to change their treatment, they can come up with the best treatment option for them.

Moretti: What are the treatment options for patients with relapsed and/or refractory multiple myeloma?

Ottoman Empire: We offer a variety of treatments. There are immunomodulators, usually in tablet form. Steroids can be given as tablets or intravenously. There are proteasome inhibitors such as Velcade (bortezomib) and Kyprolis (carfilzomib). (Velcade) can also be administered subcutaneously as well as intravenously, but subcutaneous administration is preferred as it has the fewest side effects. (Kyprolis) is usually given by infusion. And there are antibodies available for patients such as Darzalex (daratumumab), Sarclisa (isatuximab) and Empliciti (elotuzumab).

Then there is the bispecific antibody Tecvayli (teclisttamab), which is approved not only for CAR-T cell therapy, but also for relapsed refractory myeloma. Thus, there are two CAR-T cell therapies Abecma (idecabtagene vicleucel) and Carvytki (cilta-cel) available. We also offer stem cell transplantation as a treatment for patients. I also have oral treatments like psychocyclophosphamide and melphalan, so I have old-school chemotherapy drugs at my disposal. And in addition to all of these different treatments, there are many clinical trials examining different options for patients with relapsed and refractory space.

Moretti: Are there other risk factors that may play a role in treating relapsed and/or refractory multiple myeloma?

Ottoman Empire: that’s right. Of course, we also examine the patient for comorbidities and general condition, the types of treatments the patient received, the type of response the patient had, and the side effects endured due to those treatments. and the extent to which the sequence affects organ function. Next, from a disease perspective, we look at the amount and type of myeloma we are dealing with. Are there positive features like circulating plasma cells? Has the myeloma started to migrate to sites other than bone? Do you have blood flow? So we use all that information to come up with the best game plan for the patient and try to give you as much information as possible about your options.

Moretti: What is important for patients to know if their multiple myeloma becomes relapsed or refractory?

Ottoman Empire: First and foremost, we need to take action. That means you have a choice. And it makes a lot of sense to talk to your doctor and reach out to a myeloma specialist to help you make a decision. Talk to your doctor or myeloma specialist before making a decision. Be ready. And my advice is always don’t be afraid to ask questions. The question is not a silly question. And we want to empower patients as much as possible.

This transcript has been edited for clarity.