Exam 3 - Multiple Myeloma Flashcards
List risk factors for multiple myeloma (MM)?
non-Hispanic Blacks, radiation/chemical exposure, obesity, immune suppression, genetics
Explain the progression order for MM?
monoclonal gammopathy of undetermined significance (MGUS) -> smoldering MM -> MM
Explain the acronym SLMCRAB?
Sixty (minimum % of bone marrow plasma cells), Light chains, MRI (>1 focal lesion 5mm+), Calcium (>1 mg/dL), Renal (CrCL < 40 or SCr > 2), Anemia (hemoglobin >2), Bone (1+ ostelytic lesion on imaging)
What is supportive care treatment for MM? (5)
bisphosphonate therapy or denosumab (in renal impairment), erythropoietin or blood transfusions for anemia, IVIG for serious recurrent infections, acyclovir for HSV, levofloxacin for newly diagnosed
What is treatment (triplet regimen) for MM?
triplet regimen: RVd; lenalidomide (Revlimid), bortezomib (Velcade), dexamethasone
What is added-on in the quadruplet regimen for MM?
daratumumab
Which type of transplant should be given to MM patients?
ONLY AUTOLOGOUS
What is the MOA of daratumumab?
anti-CD38 1gG1-kappa human MoAB
What is another drug in the class of daratumumab?
isatuximab
What are pre-medications for daratumumab?
dex/methylprednisolone, acetaminophen, diphenhydramine/hydroxyzine, montelukast
What is the post-medication for daratumumab?
methylprednisolone
What are AEs of daratumumab? (3)
HSV/HepB reactivation, infusion-related reactions, lab interferences
What is the MOA of bortezomib?
proteasome S20 subunit inhibitor (leads to apoptosis)
What is a clinical pearl for bortezomib?
SQ preferred over IV due to dose limiting AEs
What are AEs of bortezomib? (3)
HSV reactivation, thrombocytopenia, peripheral neuropathy (bor > ixa > car)
What are clinical pearls for carfilzomib?
given IV, rare cardiac and pulmonary toxicity
What are clinical pearls for ixazomib?
given oral, taken on empty stomach, GI toxicity
What is the MOA of lenalidomide?
immunomodulatory drug; anti-angiogenic upregulation of pro-apoptotic factors, decreased production of cytokines, enhance T/NK-cell proliferation and activity
What are other drugs in the class of lenalidomide? (2)
thalidomide, pomalidomide
What are AEs of lenalidomide?
birth defects, hematologic toxicity, thrombotic events, somnolence, secondary malignancy risk, rash and skin toxicities, diarrhea, peripheral neuropathy
Explain the recommendations by the REMS program for MM therapies?
due to embryo-fetal risk, confidential surveys and highly effective birth control (IUD, pills, tubal ligation, vasectomy, etc.) and additional birth control (condom, diaphragm, cervical cap, etc.) MUST be used by patient, as well as proper administration and disposal of drugs
List risk factors for VTE from MM treatment?
prior VTE, high dose steroids, obesity, central/tunneled catheter, fracture, immunomodulatory drugs (IMiDs)
What are anticoagulation prophylactics for MM treatment-related VTE? (3)
enoxaparin 40 mg qd, apixaban 2.5 mg bid, aspirin 81 mg qd
What are AEs of dexamethasone?
insomnia, mood changes, increased appetite/weight gain, HTN, edema, GI
What is a requirement for utilizing CAR-T or BiTEs therapies?
failing 4 lines of therapy
What is the MOA of elotuzumab?
IgG anti-SLAMF7 moAb, activates NK cells against myeloma cells
What are pre-medications for elotuzumab?
dexamethasone, acetaminophen, diphenhydramine, famotidine
What are AEs of elotuzumab? (3)
HSV reactivation, thrombocytopenia, infusion-related reactions
What are the bispecific T-cell engagers? (3)
teclistimab, talquetamab, elranatamab
What is the MOA of teclistimab and elranatamab?
T-cell activation and subsequent lysis of BCMA+ MM cells
What are AEs of teclistimab and elranatamab? (3)
cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), cytopenias
What is the MOA of talquetamab?
T-cell activation and subsequent lysis of GPRC5D+ MM cells
What are AEs of talquetamab? (4)
same as teclistimab and elranatamab w/ skin/nail toxicities, taste change, weight loss
