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Hematology, oncology > multiple myeloma > Flashcards

multiple myeloma Flashcards

1
Q

RVD is…

A

Rvd = lenalidomide (Revlimid), Bortezomib (Velcade) and dexamethasone (VRd) (1 g q month).

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2
Q

newly approved agents for MM

A

monoclonal antibodies
CAR T-cell
ADC’s
BiTES

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3
Q

bortezomib MOA

A

proteasome inhibitor, protein production halts, leading to apoptosis

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4
Q

prognosis in general/progress in treatment

A

people are living longer but they are still dying (MM can’t be cured yet)

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5
Q

IMiDs means

A

immunomodulatory drugs

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6
Q

new monoclonal antibody added to RvD

A

darzalex

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7
Q

primary problems with CAR T cell therapy

A

cost + *access (not available most places)

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8
Q

sequential vs combined therapy in MM

A

combined therapy better (multiple populations of cells), so 3 drug regimens are standard of care (triplet therapy)

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9
Q

response assessment

A

M-protein level + BMB

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10
Q

How is CR defined?

A
  • NO evidence of disease in marrow or serum.
  • NO monoclonal (M) protein in serum or urine by immunofixation with no current evidence of soft tissue plasmacytoma.
  • Less than 5 percent clonal plasma cells on bone marrow aspirate
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11
Q

What is concept of MRD testing?

A

minimal residual disease

  • response criteria for MM, prognostic marker but we don’t know how it influences management yet
  • use NGS or next generation flow
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12
Q

most impt prognosticator

A

not CR, but durability of CR

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13
Q

MGUS risk of progression

A

1%

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14
Q

smoldering myeloma risk of progression

A

10%

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15
Q

Mm can progress to what?

A

Plasma cell leukemia

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16
Q

Branching concept in oncology

A

there are clonal populations of cells and subclonal

In remission in myeloma you may just be suppressing one population while another progresses

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17
Q

most common presentation of multiple myeloma

A

fatigue from anemia, bone pain, fractures

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18
Q

What are the high risk FISH markers?

A

del17p
t(4;14)
1q gain
Also (t(14:16), t(14;20)??)

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19
Q

darzalex generic name

A

daratumumab

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20
Q

what are the plasma cell dyscrasias?

A
  • Plasma cell myeloma, AKA multiple myeloma
  • MGUS
  • Solitary plasmacytoma
  • Primary amyloidosis
  • POEMS
  • Light and heavy chain deposition diseases
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21
Q

diagnostic criteria for MGUS

A

1) serum M protein >3 g/dL
2) Clonal plasma cells >10% of bone marrow
3) Absence of end-organ damage

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22
Q

diagnostic criteria for smoldering MM

A

1) serum M protein >3
2) clonal plasma cells 10-59% of bone marrow
3) no end-organ damage or other myeloma defining event

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23
Q

How is solitary plasmacytoma defined?

A

Clonal plasma cell mass + NO bone marrow involvement or end organ damage from monoclonal plasma cells. (less than 10% of clonal marrow plasma cells)
- plasmacytoma if patient has MM, is just a plasmacytoma

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24
Q

POEMS stands for

A

Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes

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25
Q

pathophys of AL amyloidosis

A

systemic deposition of amyloid protein composed of immunoglobulin light chains

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26
Q

How is MM risk stratified?

A

Primarily based on chromosomal translocations and LDH level

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27
Q

Risk stratification scoring system

A

Revised-International Scoring System (RISS)

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28
Q

Variables used for staging in R-ISS?

A

Serum B2M, albumin, LDH, and genetics (translocations)

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29
Q

general treatment approach for MM

A

Induction therapy –> collect stem cells if candidate –>

HCT or continuation on therapy if not HCT candidate

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30
Q

Stem cell transplant method used for MM

A

autologous

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31
Q

age cutoff for HSCT

A

65

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32
Q

Contraindications to HSCT at most centers in the US

A

1) Age >77 years
2) Frank cirrhosis of the liver
3) Eastern Cooperative Oncology Group (ECOG) performance status 3 or 4 unless due to bone pain (table 4)
4) New York Heart Association functional status Class III or IV

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33
Q

renal function and eligibility for HCT

A

Autologous HCT may be safely performed among patients with all stages of kidney disease, even among patients on dialysis. Renal impairment appears to have no adverse effect on either the quality of stem cell collection or engraftment following autologous HCT

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34
Q

bortezomib side effects

A

peripheral neuropathy, thrombocytopenia, herpes zoster reactivation (viral prophylaxis with acyclovir required)

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35
Q

bortezomib metabolism

A
  • hepatic, dose adjustment for liver dysfunction required
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36
Q

thalidomide SE profile

A

peripheral neuropathy, constipation, fatigue, edema, somnolence, VTE

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37
Q

lenalidomide SE’s

A

Fatigue + myelosuppression + constipation/diarrhea + peripheral edema + fever + VTE

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38
Q

lenalidomide metabolism

A

renal

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39
Q

why are bisphosphonates used in MM?

A
  • decrease risk of skeletal fractures and improve bone-related pain
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40
Q

formulation and dosing of bisphosphonates

A

Once monthly IV infusion

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41
Q

bisphosphonates SE profile

A

hypocalcemia, renal insufficiency, osteonecrosis of the jaw

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42
Q

evidence for autologous HCT in MM

A
  • Improved PFS, mixed evidence for OS
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43
Q

when are autologous hematopoietic stem cells collected after induction therapy for MM patients?

A

Usually after 2-4 months of herapy and cytoreduction by 50% (partial remission)

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44
Q

can someone undergo a second HCT?

A

Yes, usually enough stem cells are collected to perform two autologous HCTs

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45
Q

Treatment modification for MM patient who is candidate for autologous HCT?

A

Avoid prolonged therapy with alkylating agents (cyclophosphamide or melphalan) or lenalidomide, which can interfere with stem cell collection

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46
Q

what are the alkylating agents?

A

cyclophosphamide or melphalan

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47
Q

what does early and late stem cell transplant refer to?

A 
early = immediate transplant following induction therapy
late = transplant after relapse
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48
Q

most commonly used induction regimen for standard-risk myeloma

A

RvD (bortezomib, lenalidomide, dexamethasone)

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49
Q

management of frail patient with MM

A

Usually 2 drug regimen like bortezomib or lenalidomide with dexamethasone (VD or RD)

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50
Q

Maintenance therapy after induction and HCT

A
  • Lenalidomide-based

- consider adding Bortezomib

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51
Q

How is disease progression defined?

A
  • new serum calcium >11.5
  • increase in size of a preexisting bony lesion or plasmacytoma
  • appearance of new bony lesions or plasmacytomas
  • 25% increase in serum or urine monoclonal immunoglobulin, bone marrow clonal plasma cell percentage, change in kappa/lambda serum FLC ratio.
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52
Q

management of VTE risk with lenalidomide

A

IF average risk = aspirin daily

IF elevated risk = warfarin

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53
Q

Diagnosis of patient with isolated bone mass + biopsy showing 5% monoclonal plasma cells without other end-organ involvement

A

solitary plasmacytoma

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54
Q

High risk MM defined as

A

1) t(14;20)
2) t(14;16)
3) del17p
4) LDH>upper limit of normal
5) evidence of plasma cell leukemia

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55
Q

type of stem cell transplant typically used in MM

A

autologous

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56
Q

R-ISS incorporates

A

Beta2 + LDH + albumin + FISH

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57
Q

Factors influencing early vs delayed HCT

A

Patient preference, risk stratification (early HCT is preferred for high-risk MM), patient age (as age approaches 70, early HCT is preferred), response and tolerability to the initial chemotherapy regimen, insurance approval (some insurers do not cover stem cell harvest and cryopreservation without immediate transplantation), and whether centers have the facilities and resources for long-term storage of stem cells

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58
Q

why there is a limit to number of cycles with MM before stem cells

A

bortezomib will eventually knock out stem cells

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59
Q

revlimid regulation

A

Highly regulated because it causes a lot of birth defects. You have to fill out a form after each month. This can occasionally cause delays.

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60
Q

Revlimid formulation

A

Pill

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61
Q

Bortezomib formulation

A

Sub q injection

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62
Q

Initial workup if concern for myeloma

A

SPEP/UPEP + Serum free light chain (FLC) assay

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63
Q

what is M protein

A

Monoclonal Immunoglobulin produced by clonal population of plasma cells

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64
Q

diagnosis

A 
Clonal bone marrow plasma cells ≥10% or biopsy-proven bony or extramedullary plasmacytoma* and any one or more of the following myeloma-defining events:
Hypercalcemia (greater than 11)
Renal insufficiency (Cr>2)
Anemia (Hgb <10)
One or more osteolytic lesions
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65
Q

Imaging for lytic lesions

A

Whole body noncon CT (just looking at bone)
PET/CT
OR MRI

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66
Q

What is CyBorD regimen?

A

Cyclophosphamide + Bortezomib + Dexamethasone

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67
Q

Use of CyBorD

A

Induction therapy for patients with previously untreated multiple myeloma, prior to autologous stem cell transplantation (ASCT).

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68
Q

Initial Management of patient eligible for HCT

A

Induction therapy with a triplet regimen for three to four months to reduce the number of tumor cells in the bone marrow and peripheral blood, lessen symptoms, and mitigate end-organ damage –> stem cell collection.

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69
Q

Initial management of patient ineligible for HCT

A

8 to 12 cycles of initial therapy with a triplet regimen –> maintenance therapy until disease progression or unacceptable toxicity

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70
Q

Management of frail, old patient not thought to be candidate for triplet therapy

A

doublet therapy - hold bortezomib, given lenalidomide and low dose dexamethasone until progression

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71
Q

Why is acyclovir given?

A

Prophylaxis for herpes zoster due to bortezomib

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72
Q

Indication for PPI

A

GI ppx if receiving decadron

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73
Q

Preferred induction therapy regimens per NCCN for transplant candidates

A

RvD firstline

CyBorD if renal failure

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74
Q

prophylaxis recommendations with high dose decadron

A

1) PCP prophylaxis
2) zoster prophylaxis
3) antifungal ppx (don’t see people do this)

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75
Q

What is an SPEP and relevance to MM

A
  • Serum proteins are separated by an electrical currents into five major fractions by size and electrical charge
  • MM appears as a spike in the gamma globulin region
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76
Q

Relation of AL amyloidosis to MM

A

MM can lead to amyloidosis

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77
Q

Revlimid trade name

A

Lenalidomide

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78
Q

Bortezomib trade name

A

Velcade

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79
Q

How to test for minimum residual disease

A

NGS or next generation flow

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80
Q

Induction regimen typically used for patients with renal failure

A

CyBorD

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81
Q

Demographic RF’s for MM

A

More common in men

More common in African Americans

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82
Q

RF’s for developing MM

A

BMI

?

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83
Q

Presentation

A

Usually asymptomatic

  • fatigue/weakness from anemia
  • bone pain
  • weight loss
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84
Q

Relation of M protein to total serum protein

A

*total serum protein level may be normal in patients with MM (eg in light chain MM because free light chains seldom rises to a level that affects the total protein)

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85
Q

anemia features in MM

A

normocytic, normochromic (bone marrow replacement, epo deficiency, or dilutional effect)

86
Q

Typical location of bone pain and why

A

Central skeleton (vertebral bodies, skull/neck, ribs, shoulders, pelvis, hip) rather than the extremities (these are areas with active hematopoesis

87
Q

2 major causes of renal insufficiency in patients with MM

A

1) Light chain cast nephropathy
2) hypercalcemia
* thus patients who don’t secrete light chains aren’t at risk for kidney injury

88
Q

etiology of hypercalcemia in MM

A

Bone demineralization

89
Q

Range for K/L ratio

90
Q

Most common myeloma subtypes

A

IgG most common (half)
IgA – 20%
Kappa or lambda – 16%

91
Q

What is plasma cell leukemia in general?

A

Rare but aggressive form of MM characterized by high levels of plasma cells in peripheral blood

92
Q

Preferred imaging modalities for bone involvement and performance

A

MRI most sensitive
low dose CT second best
Plain film/skeletal survey worst

93
Q

When you need UPEP as part of the initial workup

A
  • if plasma cell proliferative disorder is identified (need to quantify M protein and total urine protein concentration)
94
Q

Indications for measuring serum viscosity?

A

M protein greater than 5 or symptoms of hyperviscosity

95
Q

Diagnostic criteria

A

1) clonal plasma cells greater than or equal to 10% or biopsy proven soft tissue plasmacytoma
AND
2) organ or tissue impairment
OR 3) presence of a biomarker associated with “near inevitable progression to end-organ damage”

96
Q

Definitions of organ impairment for MM diagnosis

A

Hgb less than 10
Serum calcium greater than 11
EGFR less than 40 or Creatinine greater than 2
Bone lesions

97
Q

Bone lesions criteria for MM diagnosis

A

One or more lesions 5 mm or greater

98
Q

What are the SLiM criteria? What does this define

A

SLiM
Sixty (60 percent clonal plasma cells in the bone marrow)
L(ight chain ratio – FLC of 100 or more)
M(RI w/ 1 or more focal lesions)
***New additional criteria defining MM (in addition to CRAB)

99
Q

What’s the most important aspect of establishing MM diagnosis?

A

Make sure end organ damage is definitively related to MM

100
Q

Natural course of MM without treatment

A

Without therapy, symptomatic patients die within a median of 6 months

101
Q

Criteria defining high-risk myeloma

A

1) High risk fish translocations
2) LDH 2 or greater upper limit of normal
3) Features of primary plasma cell leukemia (either 2000 or greater plasma cells of peripheral blood or 20% or greater on a manual diff count)

102
Q

High risk myeloma fish translocations

A

4;14
14;16
14;20
del17p13

103
Q

Optimal time for collecting stem cells

A

Early in treatment course

104
Q

Contraindications to transplant for MM

A

Age – *over 77
Liver cirrhosis
*Functional status – ECOG status 3 or 4 unless due to bone pain
NYHA Class III or IV

105
Q

Renal failure and transplant eligibility

A

Still eligible but associated with relatively high transplant-related mortality

106
Q

Preferred induction therapy regimens

A

*no standard, experts use different regimens

107
Q

Difference in induction therapy duration between patients eligible and patients ineligble for HCT

A

IF eligible –> 3-4 months

IF ineligible –> 8-12 cycles then maintenance therapy

108
Q

Efficacy of early vs. delayed transplant strategies

A

Comparable results in studies in MM

109
Q

Why allogeneic HCT is not done

A

You can be cured, but its use is limited by high early mortality rates and morbidity

110
Q

Factors influencing early vs delayed HCT

A
  • patient preference
  • risk (early preferred for high-risk MM)
  • age (early preferred for older)
  • insurance (some insurers don’t cover cryopreservation)
111
Q

Maintenance therapy for patients who aren’t transplant eligible

A

High-risk = bortezomib
Standard-risk = lenalidomide
Frail patients = lenalidomide + dexamethasone (len dex)

112
Q

When patients are typically evaluated for response

A

Before each treatment cycle

113
Q

clinical relapse means

A

Patient develops CRAB symptoms

114
Q

Lab definitions of relapse

A

1) Doubling of M protein over 2 months
2) Increase in absolute levels of M protein of greater than 1 in serum or of greater than 500 mg per 24 hours in the urine, confirmed by 2 measurements

115
Q

Treatment options for patients with relapsed or refractory MM

A

1) HCT
2) Rechallenge previous chemo regimen
3) Trial new chemo regimen

116
Q

IFE is

A

immunofixation (SPEP, UPEP)

117
Q

RRMM means

A

relapsed and refractory multiple myeloma

118
Q

Differential for M Spike

A
  • cryoglobulinemia
  • hemolysis
  • elevated fibrinogen
  • elevated CRP
119
Q

D-VrD is

A

daratumumab-VrD

120
Q

what is CyBorD

A

Cyclophosphamide + bortezomib + dexamethasone

121
Q

High risk cytogenetics

A 
17p13
t(4;14)
t(14;16)
t(14;20)
Gain 1q
LDH>2x upper level of normal
Features of primary plasma cell leukemia
122
Q

Initial therapy depends on…

A
  • Risk stratification

- Transplant eligibility

123
Q

Initial therapy for frail patients with standard risk MM

124
Q

Standard of care for eligible in patients in general

A

High dose chemo followed by autologous HCT

125
Q

Lenalidomide mechanism in general

A

immunomodulatory

126
Q

Variables used for risk stratification

A

1) Cytogenetics
2) LDH
3) beta-2 microglobulin

127
Q

Initial treatment for standard-risk MM patients who are transplant candidates

A

Induction chemotherapy with VRd

128
Q

Initial treatment for standard-risk MM patients who are NOT transplant candidates

A

D-Rd (avoid bortezomib)

129
Q

Mayo Risk categories

A

Standard risk
Intermediate risk
High risk

130
Q

General response to treatment of high-risk myeloma patients

A

These patients respond poorly to conventional therapies

131
Q

other immunoglobulin levels are

A

typically suppressed

132
Q

HIgh risk chromosomal abnormalities

A 
del 17p 
t(4;14) (controversial)
t(14;16) 
gain 1q
p53 mutation
133
Q

double-hit MM means

A

2 or more high-risk abnormalities

134
Q

Preferred induction regimen for patient with peripheral neuropathy before induction

A

KRD (kyprolis is a proteasome inhibitor that doesn’t cause peripheral neuropathy)

135
Q

KRD vs. RVD

A

there is data that KRD is better than RVD in high risk patients

136
Q

1) Revlimid vs. thalidomide

2) Most potent IMID

A

revlimid is more potent (but pomalidomide is most potent)

137
Q

KRD is

A

Kyprolis, revlimid, dex

138
Q

why is CyBoRd used for patients

A

Found o be efficacious in patients with light-chain cast nephropathy

139
Q

Regimen used for patients with extramedullary disease

140
Q

Caveat about CyBoRd

A

Always switch to RVD when renal function improves

141
Q

goal of maintenance therapy

A

prolong PFS and deepen response to induction therapy

142
Q

how is MRD assessed

A

NGS + PET/CT (but better tools are needed because 25% still relapse at 3 years)

143
Q

Role for darzalex

A

Transplant ineligible (though may become standard of care for transplant eligible)

144
Q

zoledronic acid mechanism

A

bisphosphonates

145
Q

standard-of-care duration of bisphosphonates for MM

146
Q

When you use denosumab

A

renal impairment

147
Q

how much of the cortex needs to be involved to be called lytic lesion

148
Q

First line imaging modality for skeletal lesions per the International Myeloma Working Group

A

whole body MRI

149
Q

Definition of skeletal lesions per the International Myeloma Working Group

A

More than one lesion greater than 5 mm

150
Q

Management of equivocal small skeletal lesion on MRI

A

Repeat MRI in 3 months

151
Q

Management of lytic bone lesions

A

dental referral + check vitamin D level and correct before starting
zoledronic acid 4 mg IV over 15 minutes q1 month indefinitely

152
Q

Drug class of zoledronic acid

A

Bisphosphonate

153
Q

Duration of bisphosphonate therapy in MM

A

Typically indefinite, unless in remission

154
Q

Etiology of AKI in multiple myeloma patients

A

Broad array of etiologies:

  • light chain cast nephropathy (most commonly)
  • hypercalcemia
  • volume depletion
  • nephrotoxic agents (eg, radiocontrast, nonsteroidal antiinflammatory drugs [NSAIDs])
  • less frequently, hyperuricemia or rarely hyperviscosity.
155
Q

is myeloma curative?

156
Q

why is melphalan not used in transplant eligible?

A

compromises ability to collect stem cells

157
Q

what is early transplant strategy

A
  • proceed with autologous HCT directly after recovery from stem cell collection
158
Q

what is delayed transplant strategy

A

continued therapy usually with same regimen as used for induction, go to transplant once first relapse occurs

159
Q

drug used as maintenance

A

IF standard risk – lenalidomide

IF high risk – proteasome-inhibitor

160
Q

preferred approach for high-risk MM

161
Q

lenalidomide dosing on dialysis

A

5 mg once dialysis (on dialysis days, give after dialysis)

162
Q

lenalidomide dosing options

A

1) 25 mg daily, days 1-14, q 3 weeks

2) 25 mg, days 1-21, q 4 weeks

163
Q

additional creatures beyond CRAB that classify someone as having multiple myeloma

A
  • bone marrow plasmacytosis greater than 60%

- K to L greater than 100

164
Q

Features of high risk smoldering myeloma

A
  • 20/2/20
  • presence of 20% or more bone marrow plasma cells
  • serum M protein spike of 2 or greater
  • FLC ratio greater than 20
165
Q

what is a high beta-2 microglobulin per ISS staging

A

greater than 5.4

166
Q

variables involved in ISS staging system for multiple myeloma

A

LDH – normal vs. greater than ULN
beta2
serum albumin (less than or greater than 3.5)
cytogenetics by fish

167
Q

other term for light chain cast nephropathy

A

“myeloma kidney”

168
Q

other etiologies of renal failure in myeloma patients

A
  • amyloidosis
  • light chain deposition disease
  • acquired adult Fanconi syndrome
169
Q

Creatinine threshold defining end organ damage from myeloma

A

greater than 2

170
Q

Scoring systems for thromboprophylaxis for revlimid

A

SAVED, IMPEDE

171
Q

clinical significance of hyperdiploidy

A

favorable risk feature

172
Q

Drug class to avoid in induction therapy

A

alkylating agents (melphalan), which can compromise stem-cell reserve, preventing one from acquiring an adequate stem-cell harvest

173
Q

intermediate risk features

A
  • hypodiploidy

- 13q deletion

174
Q

what is KRd regimen

A
  • carfilzomib (kyprolis)
  • lenalidomide (revlimid)
  • dexamethasone
175
Q

induction therapy options for myeloma patients with baseline neuropathy

A

1) KRD

2) SQ bortezomib

176
Q

pomalidomide mechanism

A
  • derivative of thalidomide that acts as an immunomodulator

- directly inhibits angiogenesis and myeloma cell growth

177
Q

VGPR means

A

very good partial response

178
Q

G3 neuropathy management with bortezomib

A

1) Hold until resolution

IF improved to G1, rechallenge with dose reduced SQ formulation OR give every other week

179
Q

G3 neuropathy menas

A

interfering with ADLs

180
Q

Daratumumab target

181
Q

Belantamab mafotodin (blenrep) mechanism

A

BCMA (conjugated with a cytotoxic agent, maleimidocaproyl monomethyl auristatin F)

182
Q

panobinostat mechanism

A

HDAC inhibitor

183
Q

selinexor mechanism

A

selective inhibitor of nuclear export

184
Q

afuresertib mechanism

A

AKT inhibitor

185
Q

indatuximab ravtansine mechanism

A

immunoconjugate CD138 with maytansine

186
Q

indication for bisphosphonates in multiple myeloma

A

Bisphosphonate regardless of presence of bone lesions for up to 2 years

187
Q

name for diagnostic criteria for MM

A

International Myeloma Working Group (IMWG)

188
Q

Size of lesion on MRI that defines MM

A

Greater than or equal to 5 mm

189
Q

panobinostat mechanism

A

HDAC inhibitor (histone deacetylase inhibitor)

190
Q

panobinostat toxicity

A
  • diarrhea + severe and fatal cardiac arrhythmias and EKG changes
191
Q

daratumumab mechanism

A

targets CD38

192
Q

elotuzumab mechanism

A

targets signaling lymphocytic activation molecule F7 (SLAMF7)

193
Q

what are the IMIDs?

A
  • lenalidomide
  • thalidomide
  • pomalidomide
194
Q

FLC ratio defining smoldering myeloma features

A
  • M protein >3
  • Serum free light chain ratio >20
195
Q

Management approach of patients with myeloma kidney (in general)

A

Early and aggressive treatment is necessary to avoid dialysis

196
Q

What is standard risk

A

No high-risk chromosomal abnormality

197
Q

R-ISS stage II is

A

NOT R-ISS stage I or III

198
Q

R-ISS stage I is

A
  • standard risk cytogenetics + LDH and beta-2 upper limit of normal
199
Q

Creatinine that defines myeloma in CRAB criteria

A

Creatinine greater than 2

200
Q

Thromboprophylaxis with lenalidome

A

IF no VTE RF’s → Aspirin 81 mg daily

IF high VTE risk –> prophylactic dose LMWH

201
Q

labs for plasma cell leukemia

A

Greater than 20% plasma cells in the blood

202
Q

Drugs you shouldn’t use for transplant candidates

A

alkylating agents (melphalan, which compromise stem-cell reserve)

203
Q

NCCN first line regimens for transplant candidates

A

VRD
Carfilzomib + lenalidomide + dexamethasone
D-VRD
Ixazomib, lenalidomide, dex (category 2B)

204
Q

Management of patient with G3 neuropathy who improves to G1 neuropathy after stopping bortezomib

A
  • reinitiate at dose reduced and consider giving every other week
205
Q

What is a Bence Jones protein?

A

Just monoclonal protein in the urine.

206
Q

how does standard vs high risk influence treatment?

A

Standard risk = three-drug regimens are preferred over two-drug regimens because randomized trials suggest that they improve OS
High-risk = encourage participation in clinical trials since they do less well with conventional treatment

207
Q

Car-T’s approved for myeloma

A

Cilta-cel (better response rates)

Ide-cel

208
Q

bortezomib formulation

A

Always given subcue now due to reduced peripheral neuropathy

209
Q

Preferred second line at UMass for myeloma

A

DKd (Dara-Carfilzomib/dexamethasone) (Preferred at UMass)

210
Q

Contraindications to transplant in myeloma

A

1) EF below 40%
2) Uncontrolled arrhythmias (AF not rate controlled)
3) uncontrolled CAD

211
Q

Relapsed-refractory management of patient who is frail with extensive comorbidities

A

belantamab mafodotin

Hematology, oncology (218 decks)

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