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Erez's HEM TEST notes 2024 > MM facts > Flashcards

MM facts Flashcards

1
Q

POEMS

A

Peripheral neuropathy (mandatory)
Organomegaly
Endocrinopathy
Monoclonal antibody (mandatory)
Skin changes

VEGF
Thrombocytosis

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2
Q

Benefit of ASCT in NDMM

A

DETERMINATION
VRd +- ASCT
PFS benefit (68% vs 46%)
no OS

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3
Q

DVtD vs VTd in NDMM

A

CASSIOPEA trial
VTd +- Dara (induction and maintenance)
NDMM
Age< 66
DVTd improved CR, MRD- and PFS
Double randomization- Dara induction, Dara main
no main was given to control
Benefit of Dara mainly in non dara exposed pts
PFS 80 months
Depth of response depened during dara main

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3
Q

Carfilzomib in NDMM

A

FORTE trial
KCd + ASCT vs KRd + ASCT vs KRd without ASCT
better MRD- and PFS with KRd + ASCT
KRd achieved more VGPR compared to KCd

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3
Q

Tandem ASCT in MM

A

StaMINA trial and others
improved PFS and OS in high risk pts after VRd

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4
Q

Benefit of len main in NDMM after ASCT

A

PFS (53 vs 23 mon.) and OS

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5
Q

Plerixafor

A

CXCR4 antagonist
In combination with GCSF
Improves cell collection

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6
Q

R-ISS

A

b2mg > 3.5, 5.5
Alb < 3.5
LDH
HR cytogenentics

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7
Q

DVRd vs VRd in NDMM (phase II)

A

GRIFFIN study
DVRd vs VRd
Phase II
Better PFS and deeper response

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7
Q

DVRd vs VRd NDMM phase III

A

PERSEUS
Phase III
Better 4 year PFS (85% vs 70%)
and deeper response

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8
Q

SMM progression to MM %

A

50% in 5 years
15% in next 5 years
10% thereafter

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9
Q

Mayo 2018 SMM model

A

20:2:20 model
Retrospective
Not dynamic

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10
Q

Benefit in treating HR-SMM

A

QuiRedex- Rd vs observation
OS and PFS benefit
included pts today diagnosed as MM based on SLiM and advanced imaging

AQUILA
Dara improves OS!
Very high risk pts

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11
Q

IMWG 2020 SMM model

A

Same as MAYO 2018
+ FISH abnormalities
With weighted scoring for each factor

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12
Q

Dynamic models for SMM

A

A few parameters have been found:
decreasing Hb, increasing M protein, increasing FLC ratio (or delta)
need further validation

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13
Q

Multi agent Tx in SMM

A

ASCENT- DKRd for high risk SMM
GEM-CESAR

Increases PFS but non curative

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14
Q

Relevant end points in SMM trials

A

OS
MRD negativity
PFS2
fractures
renal impairment
QOL

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15
Q

Definition of resistance to a drug in MM

A

progression while on the drug or within 60 days

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16
Q

Ven in RRMM

A

BELLINI trial
VEn-Vd vs Vd
negative trial
effective in t(11:14) and high BCL2 expression but increased mortality for the rest

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17
Q

Targets of bi-specific Ab in MM

A

Teclistamab, Elranatamab- BCMA
Talquetamab- GPCR5D

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18
Q

Ide-cell in RRMM

A

KARMMA trial
2nd+ line
phase 3
vs SOC
50% CR
Longer PFS

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19
Q

Cilta-cell in RRMM

A

CARTITUDE trial
2nd+ line
phase 3
70% CR
longer PFS

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19
Q

HRMM %

A

15-20%

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20
Q

Standard risk FISH abnormalities in MM

A

Trisomy (hyperdiploid)
t(11:14)
t(6;14)

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21
D-Rd vs Rd in NDMM
MAIA trial for transplant ineligible Including frail pts
22
Tx of RRMM
Triplets with drugs pt not resistant/exposed to: DKd - CANDOR PVd- OPTIMISMM DVd- CASTOR KRd- ASPIRE DRd- POLLUX Earlier Tx with Bispecific and CAR-T in the future
23
MRD- in HRMM
Overcomes the HR Comparble risk to SR SR pts with MRD+ are considered HR
24
HRMM FISH abnormalities
del(17p), t(4;14), t(14;16), t(14;20), gain 1q, del 1p, or p53 mutation
25
Extramedullary disease in MM %
at diagnosis 1-2% any time 8%
26
SMM diagnosis
> 3 g% M protein > 500 mg/d BJ >10% PC in BM
27
CRAB
Calcium > 11 or 1 above ULN Cre> 2, or eGFR<40 Hb < 10 or 2 g% decrease Lytic lesion on CT
28
Non secretory MM%
2%
29
Plasma cell leukemia diagnosis
>5% Plasma cells in PB
30
R-ISS stage I
- No high risk cytogenetics - Normal LDH, albumin, B2MG (3.5)
31
R-ISS stage II
Not fitting Stage I or III - No HR cytogenetic features - hypoalbuminemia or 5.5>BMG>3.5
32
R-ISS stage III
- t(4;14), t(14;16), or del(17p) or LDH + - B2MG> 5.5
33
IMiDs mechanism of action
Bind to cereblon Rapid ubiquitination and degradation Ikaros (IKZF1) Aiolos (IKZF3)
34
Elotuzumab mechanism of action
SLAMF7
35
VDT-PACE
bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide
36
2nd ASCT in RRMM
consider if PFS of >36 months after previous ASCT
37
Cilta cell vs Ida cell in RRMM
No head to head Cilta 76% CR and Ida 33% CR Similar toxicity
38
Tx of POEMS
RT to sclerotic lesions Rd is systemic disease ASCT provides long PFS but must are not candidates
39
Negative prognostic factors for response to CAR-T in MM
EMD PCL
40
Castellman disease classification
Unicentric - usually mediastinal Multicentric- HHV8, POEMS, Idiopathic (NOS, TAFRO)
41
Tx of unicentric castellman disease
Resection
42
Tx of HHV8 MCD
Rituximab
43
Tx of Idiopathic MCD NOS
Siltuximab Anti-IL6
44
Tx of TAFRO
R-CHOP +- siltuximab
45
Progression of SMM to MM
10% a year for 5 years 3% a year for 5 years Then 1% a year Based on older studies in which MM might be misclassified as SMM
46
Belantamab in RRMM
BVd compared DVd- DREAMM7 BPd ompared to PVd- DREAMM8 Better PFS for bleantamab in both studies
47
Mezigdomide
Cereblon modifying causing degradation of transcription factors researched in MM
48
Subgroup not benefiting from DVRd
Transplant eligible Age > 65
49
DVRd effect on ASCT collection
More pts needing Plerixafor
50
Pomalidomide SE
Cytopenias Thrombosis/Secondary malignancy Same as Len nut no need to dose adjust for CKD
51
Cilta-cell constact vs Ida-cell constract
CIlta-cell has 2 binding sites to BCMA
52
Prior BCMA Tx in MM pts going to CAR-T
Less response to CAR-T
53
Tx of plasma cell leukemia
DVRd + Chemo (if rapid disease) Tandem ASCT If not in CR consider Auto followed by Allo
54
Dosing of RT in solitary plasmacytoma
45-50 Gy
55
IMPEDE VTE score in MM
* Immunomodulatory agent use * Mass (Body Mass Index ≥25 kg/m²) * Pelvic, hip, or femur fracture * Erythropoietin stimulating agent use * Dexamethasone/Doxorubicin use * Ethnicity (Asian) * VTE history * Tunneled line/central venous catheter * Existing thromboprophylaxis 4 = intermediate risk
56
TEMPI syndrome
Telangiectasias Elevated EPO and erythrocytosis Monoclonal gammopathy Perinephric fluid collections Intrapulmonary shunting Tx is PCD based
57
TAFRO
Thrombocytopenia, anasarca, fever, reticulin fibrosis (or renal dysfunction), and organomegaly

Erez's HEM TEST notes 2024 (35 decks)

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