Sundar Jagannath, MD

Before closing out their review on the management of multiple myeloma, panelists consider disparities in care and share how these barriers are being addressed.

A comprehensive review of novel therapy being investigated in the setting of relapsed/refractory multiple myeloma to expand the bispecific antibody and CAR T-cell therapy armamentarium.

Shared insight on key factors that determine the best selection of therapy in patients with relapsed/refractory multiple myeloma, with a focus on bispecific antibodies and CAR T-cell therapy.

After reviewing their third patient case, expert hematologist-oncologists highlight the treatment armamentarium for relapsed/refractory multiple myeloma.

Before closing out their module on transplant-ineligible newly diagnosed multiple myeloma, panelists reflect on best treatment practices in the setting of high-risk disease.

Practical perspectives on the optimal selection of therapy for transplant-ineligible NDMM, followed by considerations for duration of therapy and dosing.

Expert perspectives on cornerstone induction therapy regimens used in patients with transplant-ineligible newly diagnosed multiple myeloma.

Switching their attention to the transplant-ineligible setting of newly diagnosed multiple myeloma, panelists center discussion around their second patient case.

Expert hematologist-oncologists consider the role of maintenance and consolidation following the completion of transplant in patients with newly diagnosed multiple myeloma.

A brief review of the role of transplant in patients with newly diagnosed multiple myeloma and how it can be best coupled with systemic treatment.

Comprehensive insight on mainstay induction therapy options for patients with transplant-eligible newly diagnosed multiple myeloma in the context of recent clinical studies.

Opening their discussion on the first patient case, expert panelists review the management of transplant-eligible newly diagnosed multiple myeloma.

This management guide covers the symptoms, diagnosis, screening, staging, and treatment of multiple myeloma, smoldering myeloma, and other plasma cell dyscrasias.

Hematologists/oncologists and other physicians can expect to encounter an increasing number of patients with multiple myeloma in the coming years. Between 1997 and 2006, the incidence rate of myeloma declined in the United States, but the burden (the number of incident cases) increased.[1]

Multiple myeloma is a disseminated malignancy of monoclonal plasma cells that accounts for 15% of all hematologic cancers. In 2009, an estimated 20,580 new cases will be diagnosed in the United States, and 10,580 Americans will die of this disease. Incidence rates for myeloma (5.3 in men and 3.5 in women) and mortality rates (3.7 in men and 2.5 in women) per 100,000 population have remained stable for the past decade.

Multiple myeloma is now the most common indication for autologous stem cell transplantation (ASCT) in North America, with over 5,000 transplants performed yearly (Center for International Blood and Marrow Transplant Research [CIBMTR] data). While the role of ASCT as initial therapy in multiple myeloma has been established by randomized studies, newer therapies are challenging the traditional paradigm. The availability of novel induction agents and newer risk stratification tools, and the increasing recognition of durability of remissions are changing the treatment paradigm. However, even with arduous therapy designed to produce more complete remissions—for example, tandem autologous transplants—we have seen no plateau in survival curves. A tandem autologous procedure followed by maintenance therapy may be performed in an attempt to sustain remission. Sequential autologous transplants followed by nonmyeloablative allotransplants are pursued with the hope of "curing" multiple myeloma. We examine how the key challenges of increasing the response rates and maintaining responses are being addressed using more effective induction and/or consolidation treatments and the need for maintenance therapies after ASCT. We argue that given the biologic heterogeneity of multiple myeloma, risk-adapted transplant approaches are warranted. While the role of curative-intent, dose-intense toxic therapy is still controversial, conventional myeloablative allogeneic transplants need to be reexamined as an option in high-risk aggressive myeloma, given improvements in supportive care and transplant-related mortality.