Editor's Note: In recent years, the treatment landscape for newly diagnosed multiple myeloma (MM) has seen numerous innovations and breakthroughs. However, these advancements have also brought new complexities and challenges. To explore these issues, the 2024 American Society of Hematology (ASH) Annual Meeting hosted an educational session titled Newly Diagnosed Multiple Myeloma: Many Choices and More Questions. This session brought together top experts in the field to share the latest research findings and clinical insights. Hematology Frontier had the privilege of interviewing the session chair, Dr. Shaji Kumar from the Mayo Clinic. He shared his perspectives on major advancements in the treatment of newly diagnosed MM, the role of autologous stem cell transplantation (ASCT) amidst emerging therapies, and management strategies for MM-related bone disease, renal dysfunction, and infections.1. Advances and Challenges in Treating Newly Diagnosed MM
Hematology Frontier: This session focused on Newly Diagnosed Multiple Myeloma: Many Choices and More Questions. As the session chair, could you discuss the significant advancements and challenges in treating newly diagnosed MM?
Dr. Shaji Kumar: The field of MM has undergone significant changes in recent years. We now have access to more drugs and more effective combinations, particularly quadruplet regimens. These regimens have shown remarkable efficacy in both transplant-eligible and transplant-ineligible patients.
Quadruplet therapies are closely associated with achieving deep responses, especially high rates of minimal residual disease (MRD) negativity. This achievement has already translated into longer progression-free survival (PFS), and we have reason to believe that improved overall survival (OS) outcomes will become evident in ongoing trials.
2. The Role of Autologous Stem Cell Transplantation in MM
Hematology Frontier: Autologous stem cell transplantation (ASCT) has been a cornerstone in MM treatment. How do you see its role evolving in light of emerging therapies?
Dr. Shaji Kumar: ASCT remains an integral part of frontline MM therapy. For patients initially reluctant to undergo transplantation, we can consider deferring the procedure until relapse without compromising OS.
In the absence of robust clinical evidence demonstrating that CAR-T cell therapy or bispecific antibodies can replace transplantation, ASCT continues to be a critical component of MM management. It offers durable responses and consolidative benefits, making it an indispensable part of treatment strategies.
3. Managing Bone Disease, Renal Dysfunction, and Infections in MM
Hematology Frontier: While immunotherapies have significantly improved survival outcomes, treatment-related adverse events still affect patients’ quality of life. Could you share your recommendations for managing bone disease, preventing infections, and providing supportive care?
Dr. Shaji Kumar: Managing symptoms is just as important as treating the disease itself. Bone disease is a common complication in MM and requires appropriate intervention. Effective options include bisphosphonates and denosumab, which can reduce the risk of skeletal-related events.
Renal dysfunction is another significant issue, particularly in patients with light chain or cast nephropathy. The most effective way to manage renal failure is by rapidly reducing serum free light chain levels with effective therapy. It is also crucial to distinguish cast nephropathy from other renal pathologies like light chain deposition disease or amyloidosis, as their reversibility differs.
Infection management is a vital component of MM care, especially with the rise of immunotherapy. Phase III trials have demonstrated that prophylactic antibiotics can significantly reduce infection risks. Given the increased incidence of infections associated with immunotherapy, incorporating prophylactic antibiotics, antiviral and antifungal agents, and intravenous immunoglobulin (IVIG) is essential for comprehensive care.
Conclusion
Dr. Shaji Kumar’s insights highlight the progress and challenges in managing newly diagnosed MM. With advancements in quadruplet therapies, transplantation strategies, and supportive care, the field is evolving rapidly. However, challenges remain in optimizing therapy sequencing, mitigating adverse events, and ensuring quality of life for patients. Continued research and innovation promise to further improve outcomes for MM patients worldwide.
