Are Side Effects Impacting Your Quality of Life?

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What Is Myeloma Action Month?

Myeloma Action Month happens every year in March to encourage individuals and groups to take actions that positively impact the myeloma community. The International Myeloma Foundation (IMF) invites YOU to TAKE ACTION because every action makes a difference!

This year, the IMF is focusing on actions that individuals and groups can take for the myeloma community to better themselves and to foster community-building

Find more information at: myeloma.org

Audience Q&A

• Open the Q&A window, allowing you to ask questions to the host and panelists. It will be sent to our moderator and panelists for discussion.

• If you have a question that does not get answered today, you can contact our Infoline at 800-452-CURE (2873) US & Canada, 1-818-4877455, or email infoline@myeloma.org.

We Want to Hear From You!

Feedback Survey At the close of the meeting a feedback survey will pop up.

This will also be emailed to you shortly after the workshop.

Please take a moment to complete this survey.

Todays Agenda *all times are written in Eastern Standard

7:00 – 7:05 PM

Welcome and Introduction Robin Tuohy, Vice President, Support Groups

7:05 – 7:15 PM

Scope of the Problem: Definition of Side Effects and Impact on Current, Future Treatment Kevin Brigle, PhD, ANP

7:15 – 7:25 PM

What are Some of the Newer Drugs and Their Side Effects?

Beth Faiman, PhD, MSN, APRN-BC, AOCN, FAAN

7:25 – 7:30 PM

Communicating Side Effects to Your Health Care Team Beth Faiman, PhD, MSN, APRN-BC, AOCN, FAAN and Kevin Brigle, PhD, ANP

7:30 – 7:45 PM

Frequently Asked Questions Beth Faiman, PhD, MSN, APRN-BC, AOCN, FAAN and Kevin Brigle, PhD, ANP

7:45 – 8:00 PM

Live Question and Answer Closing Remarks

Scope of the Problem: Definition of side effects and impact on current and future treatment

Dr. Brigle

Multiple Myeloma: Over Production of Normal Immune –Fighting Proteins, starts in the Bone Marrow Albumin gamma

Extra proteins can clog kidneys, attack bones, and bone marrow

alpha-1

alpha-2

beta

Myeloma and Treatments Both Contribute to How You Feel Myeloma cells in excess can cause symptoms:

Treatments for myeloma can cause symptoms:

• Bone pain

• Peripheral neuropathy

• Peripheral neuropathy

• Fatigue

• Fatigue

• Diarrhea/Constipation

• Infections

• Renal/kidney dysfunction

• Infections • Blood clots • Anxiety/Depression

How You Feel

What happens if Symptoms are not Treated?

• Unnecessary pain, neuropathy, GI side effects, infections • Sadness, depression, anxiety, sleep disturbance, loss of

hope, social isolation, reduced quality of life • Reduced doses and missed therapy • Ineffective therapy and disease progression

“Mides” Immunomodulatory drugs (IMIDS)

1/3 Neuropathy (PN) Thrombosis (DVT, PE) Myelosuppression

Low blood counts Heart/Lung Fatigue, weakness

Thalomid® (thalidomide)

Revlimid® Pomalyst® Velcade® (lenalidomide) (pomalidomide) (bortezomib)

✓more with dex ✓ more with dex ✓more with dex

✓ neutropenia

Kyprolis® (carfilzomib)

✓*

✓

✓anemia, neutropenia,

thrombocytopenia

✓ slow heart rate

Ninlaro® (ixazomib) ✓

✓

✓ ✓ neutropenia, ✓ ✓ neutropenia thrombocytopenia thrombocytopenia thrombocytopenia

✓shortness of breath

✓hypotension

✓shortness of breath, hypertension

✓

✓

✓ (incl sedation)

✓

✓

Renal /Kidney

✓

✓

✓

Rash

✓

✓

✓

✓ constipation

✓ diarrhea, constipation

✓ diarrhea, constipation

GI disturbance

“Mibs” Proteasome Inhibitors

✓

✓ nausea, vomiting, diarrhea

✓ nausea, vomiting, diarrhea, constipation

✓ diarrhea, constipation, nausea

“Mabs” Monoclonal Antibodies

2/3

Monoclonal Antibody Drug Conjugate

SINE Compound Xpovio® (selinexor)

Darzalex® (daratumumab)

Empliciti® (elotuzumab)

Sarclisa® (Isatuximab)

Blenrep® (Belantamab Mafodotin)

✓

✓

✓

✓

✓neutropenia

✓neutropenia, thrombocytopenia

Neuropathy (PN) Infusion reaction

Myelosuppression ✓neutropenia, Low blood counts thrombocytopenia Cardiopulmonary (heart/lung) Fatigue, weakness Rash

GI disturbance Other

✓

✓

✓ diarrhea

✓diarrhea, nausea

✓ thrombocytopenia

✓

✓diarrhea, nausea

✓nausea

✓ Anorexia, nausea, vomiting, diarrhea

✓ ocular

✓ hyponatremia

Anthracycline

3/3

Doxil® (liposomal doxorubicin)

Alkylating Agents Cytoxan® NEOSAR®

(cyclophosphamide)

ALKERAN® EVOMELA® (melphalan)

CAR-T Cell Therapy ABECMA® (idecabtagene vicleucel)

CARVYKTI® (ciltacabtagene autoleucel)

Neuropathy (PN)

✓ hypersensitivity ✓ hypersensitivity ✓ hypersensitivity ✓ Prolonged ✓ Prolonged Myelosuppression ✓ anemia, ✓ severe bone neutropenia, neutropenia, (Low blood myelosuppression, marrow ✓ neutropenia thrombocytopenia, thrombocytopenia, counts) immunosuppression suppression anemia anemia ✓ myocarditis, Cardiopulmonary arrythmias, (Heart/lung) pneumonitis Fatigue, weakness ✓ ✓ ✓ ✓ ✓ ✓ nausea, ✓ diarrhea, vomiting, nausea, vomiting, ✓ nausea, vomiting, diarrhea, oral ✓ diarrhea, nausea ✓ diarrhea, nausea GI disturbance diarrhea constipation mucositis Rash ✓ ✓ ✓ ✓ Other CRS, Neurotoxicity CRS, Neurotoxicity Infusion reaction

✓ Acute infusion reactions

✓ hypersensitivity

GI = gastrointestinal; neutropenia = low white blood cell count; PN = peripheral neuropathy; thrombocytopenia = low platelets .

What Symptoms should I look for and report?

Kidney (urine)

Bone Pain, Swelling Anywhere

Fatigue

Signs of Infection

Uncontrolled Nausea, Diarrhea, Constipation

Numbness, Tingling, Change in Sensation or Walking

Loss of Appetite

Cough, Breathing Problems, Chest Pain

Sleeplessness, Mood Swings, Depression and Anxiety

What Symptoms should I look for and report?

M ake sure to visit the IM F website for tip cards, understanding series! https://imf-d8-prod.s3.us-west-1.wasabisys.com/resource/MMSuppTipSheets_CJON2017.pdf

Newer drugs and side effects Dr. Faiman

Select Toxicities Of Newer Agents Underscore The Need For Multidisciplinary Support, Patient Education GI toxicity (selinexor, proteasome inhibitors, lenalidomide) Cytokine release syndrome, Neurotox (CART and bispecific T cell engagers)

Myelosuppression, Infection risk, Prolonged cytopenias (cellular therapies, disease)

Patient and Caregiver – Centric, supportive care Ocular toxicity (belantamab mafadotin, corticosteroids

Thrombosis Risk (Immunomodulatory drugs, Carfilzomib, disease) Peripheral neuropathy ( ixazomib, bortezomib, thalidomide)

What are the newest drugs approved since 2020?

Drug

How it works

How it is given

Side effects

Xpovio ® - Selinexor

Keeps tumor suppressor proteins in the cell

Pills , once or twice a week at home

Stomach, low blood counts, better when given with other medications

Blenrep ®- Belantamab mafadotin

BCMA

In the vein once every 3 weeks

Need to see an eye doctor before every dose

Sarclisa ®- Isatuximab

Monoclonal antibody CD38

In the vein with pomalidomide, carfilzomib

Infusion reaction risk

ABECMA® idecaptagene vicleucel

CAR T-cell therapy

A patient’s cells are taken through a machine, made into “CARS”; reinfused 4-6 weeks

Cytokine release syndrome, low blood counts can stay around, infection risk

CILTACEL® ciltacabtagene autoleucel

CAR T-cell therapy

A patient’s cells are taken through a machine, made into “CARS”; reinfused 4-6 weeks

Similar to ABECMA

Selinexor Oral nuclear export inhibitor: blocks tumor cells from exporting tumor suppressor proteins → selective apoptosis of tumor cells First month, most challenging Symptoms decrease for most with time • Low blood counts (weekly blood counts in cycle 1) • Prevent nausea and anorexia (start ondansetron day 1; olanzapine ) • Low sodium (salty snacks, oral hydration) • Diarrhea risk (oral hydration)

Belantamab Mafodotin Antibody against BCMA Can kill myeloma cells in multiple ways: • Antibody targets cytotoxic drug to myeloma cells • Antibody can recruit immune cells to kill myeloma cells

Given IV once every 3 weeks, over 30 minutes Eye exam under slit lamp, “Snellen chart” before every dose Avoid contact lenses and apply eye drops 4 times a day

Isatuximab and Daratumumab Hyaluronidase Daratumumab Hyaluronidase SC:Anti CD-38 Safety and dosing Infusion reactions less common with the shot than IV: low blood counts, infusion reaction risk, infections, stomach

Isatuximab IV: Anti CD-38 Safety and dosing Infusion reactions: the most-common reactions specific to isatuximab are mild: low blood counts, infusion reaction risk, infections, stomach

Monitor for 4 hrs after first shot Weekly for 8 weeks then every 2 weeks, then monthly

Slower first and second infusions weekly for 4 weeks then every 2 weeks

Shingles protection and premedication

Shingles protection and premedication

Newest Approvals- Chimeric Antigen Receptor T-Cell (CART) therapy Both highly effective cellular therapies for relapsed and refractory multiple myeloma against B-Cell maturation Antigen (BCMA) CARVYKTI ® - (ciltacabtagene autoleucel) •

Approved February 28, 2022

•

After 4 prior therapies

ABECMA® - (idecabtagene vicleucel) •

Approved March 27, 2021

•

After 3 prior therapies

Patient CAR-T Therapy Journey: Two Anti-BCMA Therapies Approved!!!

Patient with multiple prior therapies

Consult with CAR-T Center/MM Specialist

CAR-T Treatment Decision

Caregiver role throughout CAR-T

Patient Waits ~4-6 weeks while Lab Grows Engineered T cells

Monitor Remain near CAR-T center up to 4 weeks

Harvest T Cells

Lab Engineers T Cells

Caregiver Monitors for Signs of CRS and NT • • Fever, fatigue, malaise, sleepiness • • Low oxygen saturation • Abnormal heart rate

Nausea, vomiting, diarrhea Headache, confusion, delirium, language disturbance, trouble 23 swallowing

Side effects of Abecma Kidney  serum creatinine Renal insufficiency TLS

Liver Transaminitis  ALP Hyperbilirubinemia

Lung Hypoxia Dyspnea Capillary leak syndrome Heart Sinus tachycardia Hypotension Arrhythmias General Fever Fatigue, malaise Headache

Gastrointestinal Nausea Vomiting Diarrhea

• Monitor vital signs, Labs • Antibiotics • Protocol if need to go to ER • Early referral

Blood Anemia Thrombocytopenia Neutropenia

CRS

Musculoskeletal  CPK Myalgia Weakness

CAR-T patient’s own T cells engineered in 4 to 6 weeks – Will often need treatment in between

Neurologic Delirium Sleepy Swallowing

Communicating Side Effects to Your Health Care Team Dr. Brigle & Dr. Faiman

Know your Team! Look to them for Support Primary Hematologist, Oncologist

Advanced Practice Providers

Pharmacists

Allied Health Staff/ Triage

Radiation Oncology

Psychiatry

Physical Therapy

Palliative Medicine

Primary Care Provider (PCP)

Subspecialists (nephrology, cardiology)

Family/Support Network, Religious, Support group

Financial Navigator

Tips for talking with your provider

Navigating to IMF Publications mail-order or download 1

Go to myeloma.org

2

Select Pubs & Videos

3

Click on IMF Publications

5

5

4

Select the Understanding Series or Tip Cards

Download the Desired Publication

Frequently Asked Questions 7:30-7:45PM EST

Audience Q&A

• Open the Q&A window, allowing you to ask questions to the host and panelists. It will be sent to our moderator and panelists for discussion.

• If you have a question that does not get answered today, you can contact our Infoline at 800-452-CURE (2873) US & Canada, 1-818-4877455, or email infoline@myeloma.org.

We Want to Hear From You!

Feedback Survey At the close of the meeting a feedback survey will pop up.

This will also be emailed to you shortly after the workshop.

Please take a moment to complete this survey.

Thank You to Our Sponsors!