MM

Question 1

Number of cycles before transplant

Answer 1

3-4
Based on Proteosome inhibitor + Immumodulatory drug + Steroids

Question 2

Treatment to avoid in ASCT candidates

Answer 2

Melphalan

Question 3

Mainteneance Tx after ASCT

Answer 3

Lenalidomide
Starting 90-110 days after ASCT
10-15 mg qd

Question 4

Maintenance Tx after ASCT if cannot tolelrate lenalidomide

Answer 4

Bortezomib every 2 weeks

Question 5

Duration of meintanace Tx after ASCT

Answer 5

2 years

Question 6

Meintanance Tx after ASCT for high risk pts

Answer 6

PI +/- Lenalidomide

Question 7

Meintanance Tx after ASCT for high risk pts

Answer 7

PI +/- Lenalidomide

Question 8

Minimum 1st line for ineligible pts

Answer 8

PI/Lenalidomide + Steroids

Question 9

Triplet options for 1st line in ineligible pts

Answer 9

VRD
DVD
DVMP

Question 10

Tx of MM bone disease

Answer 10

Zoledronic acid IV- over 15-minute infusion, 4 mg once a month
Danosumab sc 120 mg once a month

Question 11

Required monitoring during Tx of bisphosphonates

Answer 11

Creatinine clearance, serum electrolytes, urinary albumin- once a month
Dental health- annually (also for danosumab)

Question 12

Acyclovir prophylxis

Answer 12

Seropositive for HSV or VZV
Bortezomib Tx
Daratumumab Tx

Question 13

Resprim prophylxis

Answer 13

R/R MM
Dexamethasone ≥40 mg/day for 4 days per week

Question 14

Revaccination after ASCT

Answer 14

6-24 after HSCT
Including VZV vaccine

Question 15

High risk

Answer 15

t(4:14)
t(14:16)
t(14:20)
del(17p)
gain(1q)
p53 mutation

Question 16

Double hit

Answer 16

Two or more high risk features

Question 17

Drugs

Answer 17

Alkylating agents (Cyclophosphamide, melphalan)
Immunomodulatory drugs (Lenalidomide, Thalidomide, Pomalidomide)
Proteasome inhibitors (Bortezomib, carfilzomib, ixazomib)
Corticosteroids
CD38 inhibitors (Daratumumab, isatuximab)
Elotuzumab- SLAMF7 inhibitor
Selinexor- XPO1 inhibitor
Penobinostat- histone deacetylase inhibitor

Question 18

Factors for Tx dicesion

Answer 18

HSCT eligibility
Risk stratification

Question 19

Preferred 1st line for eligible pts

Answer 19

VRd
An alternative is :
DRd

Question 20

Tx of pts presenting with AKI

Answer 20

VCd

Question 21

Tx of plasma cell leukemia/Extramedullary disease

Answer 21

VDT-PACE

Velcade
Dexamethasone
Thalidomide
-
cisPlatin
Adraimycin
Cyclophsphamide
Etoposide

Question 22

Supportive care

Answer 22

Lenalidomide- VTE prophylaxis
Bortezomib- HSV prophylaxis
Dexamethasone- PCP prophylaxis
All new pts- Levofloxacin for 2 cycles

Question 23

Benefit of ASCT

Answer 23

Not curative
improves OS by 12 months

Question 24

Conditioning before ASCT

Answer 24

Melphalan

Question 25

Timing of ASCT

Question 26

Thaildomide pivotal study

Answer 26

CASSIOPEIA
Dara-VTD as 1st line

Question 27

Thalidomide SE

Answer 27

Peripheral neuropathy
Somnolence
VTE
Constipation

Question 28

Thalidomide benefits

Answer 28

Minimal myelosuppression
Minimal renal clearance- useful in AKI

Question 29

VGPR

Answer 29

M protein detectable on immunofixation but not on electrophoresis
or
>90% reduction of M protein
and
M protein in urine < 100 mg/d

Question 30

CR

Answer 30

Negative immunofixation in serum and urine
and
< 5% plasma cells in BM
and
No plasmacytomas

Question 31

PR

Answer 31

> 50% reducition on M protein
and
BJ reduction of >50% or < 200 mg/d
or
if M protein not detectable- FLC reduction of >50%

and

> 50% reduction of the diameter of plasmacytomas