IMF Virtual Regional Community Workshop (RCW) - IL, IN 2021

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Welcome and Announcements

Kelly Cox, Senior Director Regional Community Workshops 2

Thank you to our sponsors!

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Workshop Video Replay & Slides As follow up to today's workshop, we will have the speaker slides and a video replay available.

These will be provided to you shortly after the workshop concludes.

4

We want to hear from you!

Feedback Survey Please take a moment to complete the survey.

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

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Survey Click Here to complete the feedback survey

Indiana and Illinois Area REGIONAL COMMUNITY WORKSHOP Saturday August 7, 2021~ Agenda

Welcome and Announcements Kelly Cox, Senior Director Regional Community Workshops Myeloma 101 and Frontline Therapy Rafat Abonour, MD, Indiana University School of Medicine, Indianapolis, IN Q & A with Panel Stretch Break Relapsed Therapy and Clinical Trials Agne Paner, MD, Rush University Medical Center, Chicago IL Q & A with Panelist How to Manage Myeloma Symptoms and Side Effects Kathleen Colson, RN, BSN, BS, IMF Nurse Leadership Board, Dana-Farber Cancer Institute, Boston, MA Q&A with Panel

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Myeloma 101 and Frontline Therapy

Rafat Abonour, MD, Indiana University School of Medicine, Indianapolis, IN 7

Multiple Myeloma Overview Rafat Abonour, M.D. Harry and Edith Gladstein Professor of Cancer Research

Multiple Myeloma: The First Recognized Case • A 39 year old woman developed severe back pain in 1840.

• Two years later she developed severe pain while her husband was carrying her from the fireplace area to the bed.

• A bitter infusion for her poor appetite was given, but the patient refused it.

• Two years later she was admitted to St. Thomas Hospital and was allowed wine, mutton chop, and a pint of porter daily.

The First Recognized Patient

Sara Newberry first published pt in 1844, by Dr. S. Solly, termed condition Mollities Ossium

Multiple Myeloma in 1844

• • •

Despite the infusion of orange peel and giving rhubarb pills, she died five days later and autopsy was performed.

Section of the bones revealed marked destruction. The majority of the nucleated cells had a clear oval outline with 1-2 nucleoli.

Solly believed the process to be inflammatory and that it has begun with a morbid action of blood vessels in which an earthy matter of the bone is absorbed and thrown out by the kidneys and the urine.

•

Solly, 1844:Remarks on the pathology of mollities ossium with cases.

Medical and Chirurgical Transaction of London, 27, 435-61.

The Cells seen by Sir Solly

CP1123175-2

Plasma cells make antibodies (immunoglobulin) to fight bacteria and viruses

B cell

Plasma cell

SURVEILLANCE “RIGHT FIT”

REPLICATION & MASSIVE ANTIBODY PRODUCTION

Myeloma is a cancer of plasma cells • Myeloma = too many plasma cells • Each myeloma cell (clone) makes and releases one type of antibody (gamma globulin) into the circulation (monoclonal gammopathy)

Potential Causes of MGUS/Myeloma New Data • Detailed studies of toxic chemicals with metaanalyses*  Clear links to cancer  Roundup (glyphosphate)/benzene/PFAs implicated**  Also data on : 1,3-butadiene, ethylene oxide, vinyl chloride/bromide • Younger age (25-49 years) linked to higher risk and obesity*** *Zhang et al (Berkeley) mutation research, 2019 Teras et al (American Cancer Society) Int J of Cancer, 2019 EPA 2019: IARC reports **Perfluoroalkyl compounds in cooking pots, shampoos, makeup ***See blog: Obesity, myeloma and younger age of onset

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Myeloma Baseline Testing Test 1.

2.

3.

4.

5.

M-spike (SPEP; UPEP; IFE) Complete blood count Full chemistry panel Freelite Serum β2 microglobulin and LDH (for ISS staging) 6. Bone marrow (% PC; FiSH) 7. Imaging (X-ray; CT; MRI; PET)

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Detecting the monoclonal protein in the serum of Multiple Myeloma Patients Serum Protein electrophoresis (sPEP)

Normal profile

MAYO CLIN PROC. 2001;76:476-487 © 2001 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH

Monoclonal protein = M-spike

Role of Mass Spectrometry 1. Very sensitive test for M-component measurement 2. Practical commercial method 3. Also identifies MoAbs 4. Will change diagnostic/response criteria 5. Affordable (projected: $180) blood test … can become new endpoint for response, “biochemical relapse” and maybe MRD testing!

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With mass spec… M-Protein and Dara Both Detecte 231

Old

SPEP

0.29 g/ dL dL 0.31 g/ 0.32 g/dL

Serum Protein Electropho resis

Immunofix ation

18

7000

4000 50006000

2511 9000

16 10 6000 8000 3500 5000 4000

5000 3000

2500 30004000 KAPPA KAPPA KAPPA KAPPA

Mass Fix

4000

914 20 7000 8 12

GAMMA

Dara Dara M-Prot M-Prot

KAPPA

4 32 1

GAMMA GAMMA GAMMA

KAPPA KAPPA KAPPA

M-Prot

6000 7

50006

3000 2000

3000

2000

1500

M-Prot

8 5 4000

Dara Dara

10 46

2000 3000 2000

1000 1000

1000 1000

500

0 0 0 0

2 143

1510

GAM M A GAM M A (10^3) GAM M AM (10^3) GAM A (10^3)

New

IFE

3 4 2000

52 2 1000 1 0 00 0

10.5 10.5 10.5 10.5

11.0 11.0 11.0 11.0

11.5 11.5 11.5 11.5

m/z

12.0 12.012.0 12.0

M-Prot

Dara

12.5 12.512.5 12.5

m/z

10 M-Protein : 90 Dara 50 M-Protein : 50 Dara No Dara90 M-Protein : 10 Dara

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Myeloma Bone Disease

Myeloma in hand

Myeloma in the orbit

MRI (with contrast or STR images) very useful to delineate problems

Staging with FDG-PET/CT and MRI PET

MRI

PET: Focal lesions F

F

F

D D D D

D

F

D

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Recommended Imaging Old

New

Traditional skeletal survey with x-rays

WBLDCT

PET/CT

Best for early screening for bone disease

Response assessmen t: active residual disease

MRI

WB/spine + pelvis

Gold standard to assess bone marrow involvement 25

FiSH

Fluorescent in Situ Hybridization

GEP

Gene Expression Profiling

High risk FiSH

High risk GEP

t(4;14), 17p –, t(14;16), t(14;20), 1q +

70 gene profile

Drach J, ASH 2012

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Risk Assessments

New

High Risk Classification • 17p-/p53 mutations • t(4;14) • 1q+ • t(14;16) or t(14;20) • Double hit – 2 high risk factors (e.g. 17p- plus 1q) • Triple hit – 3 high risk factors

No clear guidelin es

Management Strategies • No upfront approach yet • Treat at relapse < 12 months • Explore new regimens 27

Impact of Cytogenetic/ FISH based stratification P < 0.001 Proportion surviving

FISH Standard risk (86%, median OS=NR)

FISH High risk (14 %, median OS= 3 years)

Follow up from Diagnosis (years) High risk abnormalities t (4, 14), t (14;16), t(14;20) Deletion 13q/ monosomy 13 (metaphase cytogenetics) Del 17p Del 1p/ Amp 1q Kumar S, Blood. 2012;119(9):2100-2105

In the absence of trisomies

Natural History

Kyle et al, NEJM, Volume 356:2582-2590, June 21, 2007

Progression to Symptomatic MM

Kyle et al, NEJM, Volume 356:2582-2590, June 21, 2007

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Baseline Testing Required for Myeloma Diagnosis MGUS

Smoldering

Early Active

Active Myeloma

Spike on SPEP/UPEP Abnormal Freelite Bone Marrow <10% PC Spike ≥ 2 G/dl Freelite ratio ≥ 20% Bone Marrow ≥ 20% PC

MGUS

HR SMM

Bone Marrow ≥ 60% PC

1

Freelite Ratio ≥ 100

2

Creatinine Clearance < 40 mi/min

3

MRI 2 or more lesions

4

M DE

Calcium Elevation

C

Renal dysfunction: Creatinine Elevation

R

Anemia

A

Bone Lesions:

B

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Indications for Considering Treatment (IMWG Guidelines) •

• • • •

At least one of the CRAB Criteria (evidence of end organ damage) Hypercalcemia

Serum calcium >2.75 mmol/L (>11 mg/dL)

Renal Failure

Serum creatinine ≥ 2 mg/dL or creatinine clearance <40 mL per min

Anemia

Hemoglobin >20 g/L below the lower limit of normal, or a hemoglobin value <100 g/L

Bone

Lytic lesions, pathologic fractures, or severe osteopenia

≥60% clonal bone marrow plasma cells Serum involved/uninvolved free light chain ratio ≥100 >1 Focal bone lesion (≥5mm) on MRI Use your Clinical judgment when using these criteria Rajkumar, et al. Lancet Oncology. 2014;15(12):e538-48.

Revised International Staging System for Multiple Myeloma

Prognostic Factor ISS Stage

• I -Serum β2-microglobulin <3.5 mg/L, serum albumin >3.5 g/dL • II- Not ISS stage I or III • III- Serum 2-microglobulin >5.5 mg/L

AND/OR LDH

Normal Serum LDH: <the upper limit of normal High Serum LDH: > the upper limit of normal

AND/OR Cytogenetic*

High Risk: • del(17p) • t(4;14) • t(14;16) Standard risk No high-risk CA

Stage I

Intermediate Risk

Stage III

ISS Stage I

ISS Stage II

ISS Stage III

AND Normal AND No high Risk

AND

Not R-ISS Stage I or III

*Based on the Updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines 2013 Mikhael JR et al. Mayo Clin Proc. 2013;88:360.

High AND/OR High Risk

New Criteria for HR SMM • M-component level ≥ 2 gm/dl • BMPC ≥ 20%

2 or more

• sFLC ratio (involved/uninvolved) ≥ 20 • Presence of 1q+ and/or 13q- confers added risk *Mayo team: Blood Cancer Journal 8:59 2018.

Risk stratification based upon 421 patients. Follow up for ~3000 patients being finished.

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Risk of Progression for SMM 2/20/20 plus 1q+/ 13q-

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The Future of Myeloma Therapy MM MGU S

HR SMM

Low risk High riskLow risk New HR Ultra MGUS MGUS SMM SMM high risk 2/20/ 20

Monitor

MD E

New CR AB

HR BR

Treat as MM

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Current Therapies Frontline • Rd: Revlimid dex Vd: Velcade dex • VRd: Velcade Revlimid dex KRd: Kyprolis Revlimid dex • DRD • DKRD • ASCT: autologous stem cell transplant

Maintenanc e Revlimid ± Proteasome Inhibitor

…. Plus new agents in trials

Relapse • • • • • • • • • • •

Daratumumab Carfilzomib Isattximab Pomalidomide Elotuzimab Ixazomib Belantamab Selinexor Idecabtagene Cyclophosphamide VDT-PACE

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Multiple Myeloma in 2021 • Testing including novel laboratory testing and better imaging may help detect myeloma at earlier stages • We are working on treating early myeloma with hope for curing myeloma before causing irreversible harm to the patients • Depth of response is very important, getting rid of myeloma makes you live longer • Patients are living much longer due to the use of combination therapies and eradicating minimal residual disease

Audience Q&A with Panel

Type and submit your questions here. Click the Q&A icon circled below if you have minimized the Ask Question window.

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BREAK 10 minutes 41

Agenda After the Break Relapsed Therapy and Clinical Trials Agne Paner, MD, Rush University Medical Center, Chicago, IL Q & A with Panelist How to Manage Myeloma Symptoms and Side Effects Kathleen Colson, RN, BSN, BS, IMF Nurse Leadership Board, Dana-Farber Cancer Institute, Boston, MA Q&A with Panel

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Relapsed Therapy and Clinical Trials Agne Paner, MD, Rush University Medical Center, Chicago, IL 43

Clinical trials and treatment of relapsed Multiple Myeloma

Agne Paner, MD Associate Professor of Medicine Director of Multiple Myeloma and Amyloidosis Program Rush University Cancer Center August 7th, 2021

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What we will cover • • •

Why do we do clinical trials ABCs of clinical trials Updates in treatment of relapsed multiple myeloma: •

Comparing different anti-BCMA therapies

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Why do we do clinical trials?

Patients ask…

Research question…

• How did I get MM?

• What causes MM?

• What is my stage?

• How can we predict prognosis?

• Will I pass it to my children?

• Is there genetic predisposition to MM?

• What can I do about my cancer?

• Should I participate in a clinical trials?

• Which treatment option is the best?

• Can we improve current standard of care or explore new treatments?

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Advances and Improvement in Survival in MM over the time Elotuzumab Daratumumab Bortezomib Panobinostat Lenalidomide Ixazomib Thalidomide Pomalidomide Melphalan Corticosteroids

1958

1962

DaraPomDE loPomD

Melflufen Car T Cell: Ide-Cel Selinexor

Carfilzomib

ASCT

1983

DaraLenD DaraBorD

Belnatamab 1999

2002

Median OS 64mo

72mo

2012 2015 2013

2016 2018 2019

2020

2021

29.9mo <12mo 1958

1971-1998

2001-2005

2006-2011

2015-

Kumar, et al. Leukemia. 2014;28:1122-1128. Kumar, et al. Blood. 2008;111:2516-2520.

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All the treatments we have today are a result of clinical trials Preclinical research:

Trials with humans: Phase I – is it safe?

Phase II – how many will respond?

Phase III –Is new treatment better than standard?

Laboratory research Animal models

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Road blocks in myeloma journey:

Natural history and treatment course of MM: ASCT transplant Maintenance

Newly diagnosed

Early relapse

Multiple relapses

Nature of trials by timeline: Phase III Is new treatment better than what is standard?

Phase I/II Is it safe, do patients respond?

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Terminology in the clinical trials • What phase is the trial • What patient population participated in the trial • Randomized: computer decides which treatment patient will receive • Overall Response Rate: how many patients had at least 50% reduction in tumor • Progression free survival: how long patient remained in remission • Duration of response: how long patients who responded remained in remission • Overall survival: how long patients lived after starting this treatment • Adverse events: side effects during clinical trial

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Classification of drugs available for treatment of MM

Alkylators

Imids

Proteasome Anti-CD38 inhibitors Monoclonal Abs

Anti-BCMA therapies

XPO1 inhibitor

Melphalan

Thalidomide

Bortezomib

Belantamab mefadotin

Selinexor

Cyclophosphomide

Lenalidomide

Ixazomib

Car-T cells

Bendamustine

Pomalidomide

Carfilzomib

BiTes

Melflufen (melphalan flufenamide)

Daratumumab

Isatuximab

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Therapies targeting BCMA: BCMA-targeting modalities Antibody-drug conjugate

T-cell activating strategies CAR T-cell therapy

Bispecific antibody

BCMA, B-cell maturation antigen; CAR, chimeric antigen receptor.

Cho SF et al. Front Immunol. 2018;9:1821. doi:10.3389/fimmu.2018.01821.

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How does it work: Belantamab mefadotin

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Things to know: Belantamab • In a phase 2 clinical trial patients refractory to three prior lines of therapy, including Imids, proteasome inhibitors and daratumumab had 30% response rate.

• Among patient who responded (DOR), remission lasted about a year.

• Belantamab can cause: • dry eyes, • impaired vision • changes in the lining of cornea, that may not cause symptoms, but can be seen on a slit lamp exam.

• Eye exam required every 3 weeks • Eyes recover when drug is held and patients can be treated again.

• Holding drug is safe – vast majority of patient remain in remission while holding drug for eye side effects.

Lancet Onocology 2020

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Strengths and weaknesses: Belantamab Strengths

Weaknesses

Easy access, available in each office

Ongoing therapy

Convenient schedule: intravenous 30min infusion every 3 weeks

Side effect of dry eyes and impaired vision

Well tolerated except for side effects for eyes

Requires eye exam every 3 weeks by eye care professional

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How does it work: BiTes (Bispecific T cell engagers)

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Things to know: BiTes • Currently in clinical trials only • Administered intravenously or Sq, weekly-every three weeks.

• Response rates range from 60-70% • During initial cycles can cause cytokine release syndrome (CRS) • Can cause neurotoxicity

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Strengths and weaknesses: BiTes Strengths

Weaknesses

Currently available only through clinical trials

Ongoing therapy

High response rates Too early to say how long remission will last

Risk of CRS with first cycles

Schedule varies from weekly to every three weeks.

Administered IV or SQ

Risk of neurotoxicity (ICANS)

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How does it work:

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Things to Know: Ide-Cel • First FDA approved anti-BCMA Car T-cell for treatment of RRMM • CarTcells are one time administration treatment, but require hospitalization.

• Only approved centers can administer CarTcells • After collection of Tcells, it takes about a month to manufacture them.

Bridging therapy may be needed.

• Response rate 73%: • 26% of patient with very deep, MRD negative response

• PFS 8.8months • Cytokine release syndrome in 84% of patients, but mostly mild • 18% with neurotoxicity NEJM 2021

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Strengths and weaknesses: Car T cells Strengths

Weaknesses

One and done treatment

Requires hospital admission

High response rates and duration of response

Logistics can be difficult: Need to travel to specialized center Delays due to manufacturing shortage Risk of CRS

Risk of neurotoxicity (ICANS)

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Upcoming therapies: Cilta-Cel • Cilta-cel, a CAR T-cell therapy with two BCMA–targeting singledomain antibodies • Response rate 97%, majority very deep response (MRD negative 91% among 61 evaluable) • Duration of response 21months • Cytokine release syndrome in 94% of patients, but mostly mild • Neurotoxicity in 20%

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Future directions • Novel therapies in combination of FDA approved therapies: DREAM5 trial at RUMC • Introducing anti-BCMA therapies, including CarTcells in earlier lines of treatment.

• New targets different from BCMA for novel immunotherapies.

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Thank you agne_paner@rush.edu

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How to Manage Myeloma Symptoms and Side Effects Kathleen Colson, RN, BSN, BS, IMF Nurse Leadership Board, Dana-Farber Cancer Institute, Boston, MA 66

Be the Commander of Your Galactic Journey: Navigating the Journey Kathleen Colson, RN, BSN, BS Dana-Farber Cancer Institute Regional Community Workshop – IL, IN August 7, 2021

Patient Education Slides 2021

You are in the Commander’s Chair

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All Crew Members are Needed for a Successful Journey

Navigating the Journey

• You and your Subspecialists

Primary Care Provider (PCP)

caregiver are the center

General Hem/Onc

• Understand the

different roles of your health care team

You and Your Caregiver(s)

Family/Support Network

Allied Health Staff

Myeloma Specialist

• Understand how they can help you

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Be an Empowered Patient “Scotty, We Need More Power!”

• Participate in decisions • Ask for time to consider options (if needed/appropriate)

• Understand options - Use reliable sources of information - Use caution considering stories of personal experiences

• Create a dialogue • Express your goals/values/preferences • Arrive at a treatment decision together

Navigating the Journey

HCP Clinical Experience

Data From Research TREATMENT DECISION

Your Preference Philippe Moreau. ASH 2015.

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Preparation for Appointments in the COVID Era

Health in the COVID Era

Preparation

Appointment

Back Home

• Write down your questions and concerns including about COVID • Bring current medications and supplements • Any medical or life changes since your last visit?

• Current symptoms - how have they changed?

• Remember your mask • Ask your most important questions first • Understand your treatment plan and next steps • Have a list of who to contact and when • Include a Caregiver for another “set of ears”

• Take precautions to stay healthy • Communicate with other members of your health care team (pharmacist, others) • Take your medications as directed • Follow up with members of your heath care crew

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Consider Telemedicine Visits

Tune Up Health in the Your COVID Era Knowledge

• Check with your healthcare provider(s) to see if telemedicine is an option • Plan as if for an in-person appointment PLUS – Ask provider for telemedicine process (tips/info, how to make appt, if any copay needed, etc.)

– Plan your labs: are they needed in advance? Do you need a script?

– Plan your technology: smartphone or tablet with camera are preferred – Plan your location: strong wifi, quiet, well-lit location is best – Plan yourself: consider if you may need to show a body part and wear accessible clothing – Collect recent vital signs (blood pressure, temp, heart rate) self-serve blood pressure cuff is available at many pharmacies – At the end of the visit: check future appointments (virtual or in-person), testing, medication refills

IMF Telemedicine Tip Sheet. In development.

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Infection Prevention & Treatment • Compromised immune function comes from multiple myeloma and from treatment • Good personal hygiene (skin, oral) • Environmental control (wash hands, avoid crowds and sick people, etc) • Growth factor (Neupogen [filgrastim]) • Immunizations (NO live vaccines) • Medications (antibacterial, antiviral)

Health in the COVID Era

Report fever of more than 100.4°F, shaking chills even without fever, dizziness, shortness of breath, low blood pressure to HCP as directed.

Infection is serious for myeloma patients!

– New research: for patients receiving active myeloma therapy, levofloxacin 500 mg once daily for 12 weeks reduced infection (fevers, death) (ASH 2017 #903)

Brigle K, et al. CJON. 2017; 21(5)suppl:60-76.

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The Best Way to Prevent Illness Is to Avoid Being Exposed • Virus spreads from person-to-person through respiratory droplets • Respiratory droplets are from coughs, sneezes, talking of an infected person – More droplets with louder talking, yelling, singing

• Close contact (within 6 feet) increases risk of spread • Droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs • COVID-19 may be spread by people who are not showing symptoms COVID Images: CDC CDC = Centers for Disease Control; COVID-19 = coronavirus 2019.

CDC website. How to Protect Yourself & Others. Accessed October 22, 2020.

Health in the COVID Era

Myeloma and Treatments Both Contribute to How You Feel

Constellation of Symptoms

Myeloma cells in excess can cause symptoms

Treatments for myeloma kill myeloma cells but can cause symptoms

• Calcium elevation

• Fatigue

• Myelosuppression

• Renal dysfunction

• Infection

• Peripheral neuropathy

• Anemia

• Other symptoms

• Fatigue

• Bone pain

• Diarrhea

• Deep vein thrombosis • Infection (eg, shingles) • Other symptoms

How You Feel 74

What Happens if Symptoms Are Not Managed Effectively?

Poorly managed symptoms can lead to...

• Anxiety • Depression • Social isolation • Missed doses • Reduced treatment efficacy • Reduced quality of life

Constellation of Symptoms

Discuss how you feel with your team...

• Keep a symptom diary; discuss with team • Many options but your team cannot help if they don’t know • Express your priorities – Fatigue is common concern but making the right treatment decision is higher priority for most

Faiman, B. CJON. 2017, 21(5)suppl 3-6. Faiman, B. et al 2017. Patient Reported Symptoms, Concerns and Provider Intervention in Patients with Multiple Myeloma

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Steroid Side Effects and Management Steroid Side Effects • Irritability,

mood swings, depression

• Difficulty sleeping

(insomnia), fatigue

• Increased risk of

infections, heart disease • Muscle weakness, cramping

• Blurred vision, cataracts • Flushing/sweating • Stomach bloating,

hiccups, heartburn, ulcers, or gas

• Weight gain, hair

thinning/loss, skin rashes

• Increase in blood

sugar levels, diabetes

Constellation of Symptoms

Managing Steroid Side Effects • Consistent schedule (AM vs. PM) • Take with food • Stomach discomfort: Over-the-counter or prescription medications • Medications to prevent shingles, thrush, or other infections

Steroids help kill myeloma cells.

Do not stop or adjust steroid doses without discussing it with your health care provider.

• Increase in blood pressure,

water retention

King T, Faiman B. CJON. 2017; 21(5)suppl:240-249. Faiman B, et al. CJON. 2008;12(3)suppl:53-63.

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Fatigue, Depression, and Anxiety

Constellation of Symptoms

• All can effect quality of life and relationships • Sources include anemia, pain, reduced activity, insomnia, treatment toxicity, bone marrow suppression

Management

• Exercise (walking, yoga, etc) • Proper rest • Support (social network, support group, professional counseling, etc) • Prayer, meditation, spiritual support • Mindfulness-based stress reduction

• • • • •

Medications Massage, aroma therapy Supplements: ginseng Transfusion, if indicated Effective management of other symptoms

At least 70% of patients experience fatigue, but only 20% tell their provider. Let your provider know about symptoms that are not well controlled or thoughts of self harm.

Catamero D et al. CJON. 2017; 21(5)suppl:7-18. Faiman, B. et al 2017.

Patient Reported Symptoms, Concerns and Provider Intervention in Patients with Multiple Myeloma.

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Infection Prevention & Treatment • Compromised immune function comes from multiple myeloma and from treatment • Good personal hygiene (skin, oral) • Environmental control (wash hands, avoid crowds and sick people, etc) • Growth factor (Neupogen [filgrastim]) • Immunizations (NO live vaccines) • Medications (antibacterial, antiviral)

Constellation of Symptoms

Report fever of more than 100.4°F, shaking chills even without fever, dizziness, shortness of breath, low blood pressure to HCP as directed.

Infection is serious for myeloma patients!

– New research: for patients receiving active myeloma therapy, levofloxacin 500 mg once daily for 12 weeks reduced infection (fevers, death) (ASH 2017 #903)

Brigle K, et al. CJON. 2017; 21(5)suppl:60-76.

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Pain Prevention and Management

Constellation of Symptoms

• Pain can significantly compromise quality of life • Sources of pain include bone disease, neuropathy and medical procedures • Management – Prevent pain when possible • Bone strengtheners to decrease fracture risk; antiviral to prevent shingles; sedation before procedures – Intervention depends on source of pain – May include medications, activity, surgical intervention, radiation therapy, etc – Complementary and alternative medicine (supplements, acupuncture, etc)

Tell your health care provider about any new bone pain or chronic pain that is not adequately controlled

Faiman B, et al. CJON. 2017;21(5)suppl:19-36.

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Knowledge is Power You are not alone - IMF has many resources to help you

Website: http://myeloma.org

eNewsletter: Myeloma Minute

Download or order at myeloma.org

Videos

IMF TV Teleconferences

Audience Q&A with Panel

Type and submit your questions here. Click the Q&A icon circled below if you have minimized the Ask Question window.

81

Workshop Video Replay & Slides As follow up to today's workshop, we will have the speaker slides and a video replay available.

These will be provided to you shortly after the workshop concludes.

82

We want to hear from you!

Feedback Survey Please take a moment to complete the survey.

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

Survey Click Here to complete the feedback survey

83

Thank you to our sponsors!

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