Newly Diagnosed Myeloma Patients and Their Caregivers

IMF Special Educational Session

What a Newly Diagnosed Patient Needs to Know Dr. Brian G.M. Durie Cedars-Sinai Outpatient Cancer Center

IMF Webinar Primer for Newly Diagnosed Patients & Caregivers April 30, 2021 9:00AM PT/ 11:00AM CT/ 12:00PM ET

Meeting Housekeeping  Zoom Control Bar –

 Technical Issues – Chat “IMF Tech. – Jon Fitzpatrick  Audio & Video – Audio - Please stay muted unless asking a question.

Our Admin Team will mute individuals as needed to prevent audio feedback.

Video - When asking a question, we’d love to see you!

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Meeting Housekeeping  Questions – “Chat” Box - Please feel free to put questions in the “Chat” box through out the meeting.

“Raise Hand” – During the Q&A portion of the meeting, please raise your hand to verbally ask a question.

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Myeloma is treatable  Over 90% of patients respond to current therapies  Average first remission is 4 years or more  In 2021, average survival is at least 7-10 years  Some patients live over 15-20+ years  New therapies are constantly improving the outlook 3

Myeloma Expert Consultation Helps!  Good to do early!  Virtual consults more available.  Sets path for future  Guides local doctor

SEE: Questions to ask your doctor https://www.myeloma.org/resource-library/tip-card-ask-your-doctor-these-important-questions

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Careful testing required for diagnosis and monitoring  Bone marrow indicates % myeloma  X-rays/ scans show where lesions* are located X-ray image of myeloma lesions in arm

Myeloma cells as seen in a bone marrow aspirate

See further discussion: “What is a lesion?” https://www.myeloma.org/bone-disease

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Careful testing required for diagnosis and monitoring  Blood tests show: blood counts; SPEP

myeloma protein level (SPEP; IFE; Freelite) plus •

calcium

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kidney function and

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liver function levels

IgG

Spike

 Urine tests can show myeloma protein level (UPEP) and evidence of kidney damage

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Other Things to Know  Myeloma is generally not hereditary (only rare families)

 Myeloma types: IgG/ IgA/ IgD/ IgE (IgM usually Waldenström macroglobulinemia)  Baseline staging important/helpful See further discussion – “Types of myeloma” https://www.myeloma.org/types-of-myeloma

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IMWG diagnostic criteria for multiple myeloma (Myeloma Defining Events)

*CRAB Criteria C R A B

https://www.myeloma.org/resource-library/international-myeloma-working-group-consensus-criteria-response-minimal-residual

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More Test Details  Bone marrow FiSH shows chromosome results  MRI and PET/CT show more lesions than x-rays FISH

PET

MRI

PET FiSH – Fluorescent in Situ Hybridization

F = Focal D = Diffuse

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More Test Details  Blood tests Tracking SPEP/IFE and blood counts essential to assess impact of treatment  Urine tests Also required for tracking + Freelite, a serum test for light chains

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Key Terminology RESPONSE  Occurs within 1-2 months

* Remission if 50% reduction sustained

 Measured by myeloma protein level  “Response*” 50% reduction = [Partial Response (PR)]  VGPR 75% reduction = Very Good PR  CR 100% reduction = Complete Response  stringent CR = sCR (Freelite normal and [BM mPCs] Bone Marrow myeloma Plasma Cells < 5%)

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Key Terminology DEEP RESPONSE  Minimal Residual Disease (MRD) Specialized testing of bone marrow negative at different levels: 10-4; 10-5; 10-6

(zero out of million)

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Key Terminology RESPONSE  Remission = response sustained with follow-up testing  Length of remission = “Progression Free Survival” (PFS) This is time during which the myeloma protein level does not go back up by 25% or more which is PD – Progressive Disease or Relapse (“biochemical” if no symptoms) 13

Key Terminology RESPONSE  Overall survival (OS) is calculated from first day of myeloma treatment Progression free survival (PFS)

41 months

Overall survival (OS) 80% = 4 years 55% = 7 years

SWOG S0777: Lenalidomide and Dexamethasone With or Without Bortezomib in Treating Patients With Previously Untreated Multiple Myeloma

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What to Expect with Treatment First “biochemical” relapse

100% Deep first response

Myeloma protein level 50%

MRD Undetected

Second response

Later relapse from MRD undetected

Possible MRD undetected

5 years

10 years 15

Treatment Options  “Triple therapy”: 3 drugs recommended •

Most common = VRd* [Rd for older/frail]

(Velcade®/ Revlimid®/ dexamethasone)  ASCT (Autologous Stem Cell Transplant)  Can be considered to achieve better response (after 3-6 months of VRd) Plus

Zometa®/ Aredia or denosumab for bone lesions

* Other options include VCd (CyBorD); KRd; Dara + Rd; Vd 16

Treatment Options  Maintenance: used to sustain remission •

Most common = Revlimid® ± Velcade®/ Ninlaro® (ixazomib)

Articles for Reference Durie B, et al. Blood Cancer Journal 2020 May 11;10(5):53.

Longer term follow-up of the randomized phase III trial SWOG S0777: bortezomib, lenalidomide and dexamethasone vs. lenalidomide and dexamethasone in patients (Pts) with previously untreated multiple myeloma without an intent for immediate autologous stem cell transplant (ASCT) https://www.nature.com/articles/s41408-020-0311-8 Usmani S, et al. Blood Cancer Journal 2018 Nov 23;8(12):123.

Clinical predictors of long-term survival in newly diagnosed transplant eligible multiple myeloma - an IMWG Research Project https://www.nature.com/articles/s41408-018-0155-7 Kumar S, et al. Leukemia. 2019; 33(7): 1736–1746.

Ixazomib, lenalidomide, and dexamethasone in patients with newly diagnosed multiple myeloma: long-term follow-up including ixazomib maintenance https://www.nature.com/articles/s41375-019-0384-1

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Caregivers Need Care Too!

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IMF Website – http://www.myeloma.org http://www.myeloma.org

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Ask your questions for Dr. Durie Type your questions and press Submit.

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