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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

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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

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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 in 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 of GCSF
improves cell collection

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6
Q

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

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11
Q

IMWG 2020 SMM model

A

same as MAYO 2018
+ FISH abnormalities

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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 RMM

A

KARMMA trial
2nd+ line
phase 3
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

Median OS of HR NDMM

A

3 years

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21
Q

Standard risk FISH abnormalities in MM

A

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

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22
Q

VRd vs Vd in NDMM

A

SWOG S0777
better OS

23
Q

D-Rd vs Rd in NDMM

A

MAIA trail
for transplant ineligible
Including frail pts

24
Q

Tx of RRMM

A

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

25
Q

MRD- in HRMM

A

overcomes the HR
comparble risk to SR
SR pts with MRD+ are considerd HR

26
Q

HRMM FISH abnormalities

A

del(17p), t(4;14), t(14;16), t(14;20), gain 1q, del 1p, or p53 mutation

27
Q

Extramedullary disease in MM %

A

at diagnosis 1-2%
any time 8%

28
Q

SMM diagnosis

A

> 3 g% M protein
500 mg/d BJ
10% PC in BM

29
Q

CRAB

A

Calcium > 11 or 1 above ULN
Cre> 2, or eGFR<40
Hb < 10 or 2 g% decrease
Lytic lesion on CT

30
Q

Non secretory MM%

A

2%

31
Q

Plasma cell leukemia diagnosis

A

> 5% PC in PB

32
Q

R-ISS stage I

A
  • No high risk cytogenetics
  • Normal LDH, albumin, B2MG (3.5)
33
Q

R-ISS stage II

A

Not fitting Stage I or III
- No HR cytogenetic features
- hypoalbuminemia or 5.5>BMG>3.5

34
Q

R-ISS stage III

A
  • t(4;14), t(14;16), or del(17p) or LDH
    +
  • B2MG> 5.5
35
Q

IMiDs mechanism of action

A

bind to cereblon
rapid ubiquitination and degradation
Ikaros (IKZF1) Aiolos (IKZF3)

36
Q

Elotuzumab mechanism of action

A

SLAMF7

37
Q

VDT-PACE

A

bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide

38
Q

Median OS of RRMM

A

9 months

39
Q

2nd ASCT in RRMM

A

consider if PFS of >36 months after previous ASCT

40
Q

Cilta cell vs Ida cell in RRMM

A

no head to head
Cilta 76% CR and Ida 33% CR
Similar toxicity

41
Q

Tx of POEMS

A

RT to sclerotic lesions
Rd is systemic disease
ASCT wit long PFS but must not candidates

42
Q

Negative prognostic factors for response to CAR-T in MM

A

EMD
PCL

43
Q

Castellman disease classification

A

Unicentric - usually mediastinal
Multicentric- HHV8, POEMS, Idiopathic (NOS, TAFRO)

44
Q

Tx of unicentric castellman disease

A

Resection

45
Q

Tx of HHV8 MCD

A

Rituximab

46
Q

Tx of Idiopathic MCD NOS

A

Siltuximab

47
Q

Tx of POEMS

A

Rd

48
Q

Tx of TAFRO

A

R-CHOP +- siltuximab

49
Q

IMWG 2020 vs Mayo 2018 in SMM

A

IMWG has weighted grading of criteria
Allowing better risk stratification

50
Q

Progression of SMM to MM

A

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

51
Q

Belantamab in RRMM

A

BPd ompared to PVd
BVd compared DVd
Better PFS for bleantamab in both studies

52
Q

Mezigdomide

A

Cereblon modifying
causing degradation of transcription factors
researched in MM

53
Q

Subgroup not benefiting from DVRd

A

Transplant eligible
Age > 65

54
Q

DVRd effect on ASCT collection

A

More pts needing Plerixafor

55
Q

Pomalidomide SE

A

Cytopenias
Thrombosis/Secondary malignancy

Same as Len

56
Q

Cilta-cell constact vs Ida-cell constract

A

CIlta-cell has 2 binding sites to BCMA

57
Q

Prior BCMA Tx in MM pts going to CAR-T

A

Less response to CAR-T

58
Q

Tx of plasma cell leukemia

A

DVRd + Chemo (if rapid disease)
Tandem ASCT
If not in CR consider
Auto followed by Allo

59
Q

Dosing of RT in solitary plasmacytoma

A

45-50 Gy

Erez's HEM TEST notes 2024 (34 decks)

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