Symposium Day Blog: Insightful Comments from Myeloma Specialists

The Friday before the official start of ASH is always considered Symposium day. Symposiums typically last a couple of hours and involve several myeloma expert doctors discussing patient cases and various treatment options.

These meetings are sponsored by advocacy organizations such as Healthtree Foundation and Research-to-Practice as well as pharma companies. (The IMF did not offer a symposium this year.) While they don’t include new information that will subsequently presented at ASH, they provide treatment suggestions currently approved by the FDA as well as consideration of ongoing clinical trials.

As such, my particular goal is to listen for insights provided by the specialists and offer those takeaways in this blog. After attending 4 symposiums, here’s what I heard:

Symposium 1: Overcoming Racial Disparities in Multiple Myeloma Outcomes and Clinical Trials (CTs): How We’re Moving Forward Today

1. Dr. Omar Nadeem: “Mortality clearly correlates to drug access.”
2. Dr. Omar Nadeem: “Black people have a higher prevalence of MGUS than white people (4% v 2%) and are 5 years younger when diagnosed with multiple myeloma.”
3. Dr. Craig Emmitt Cole: “Being poor will kill you with this disease.”
4. Dr. Craig Emmitt Cole: “In clinical trials, broaden eligibility criteria, e.g. lower absolute neutrophil count (ANC) to recognize Duffy noll syndrome, and incorporate a diversity inclusion plan.”
5. Dr. Craig Emmitt Cole: “Black myeloma patients have [higher occurrences of] t(11;14) but [lower occurrences] of del17p.”

Here is a link to the above symposium.

Symposium 2: Multiple Myeloma: Clinical Challenges for the Community Clinician

1. Dr. Ola Landgren: “Over 40 combinations are listed in NCCN Guidelines.”
2. Dr. Ola Landgren: “I feel some patients diagnosed in ’23 and ’24 will have the same lifespan as the general population.”
3. Dr. Nisha S. Joseph: “Smoldering multiple myeloma is defined as Bone Marrow Plasma Cells >= 10% and/or m-spike >= 3 g/dL, with no symptoms.”
4. Dr. Nisha S. Joseph: “Three years progression-free survival of 89% for the ASCENT trial (“curative treatment”) was the same as Revlimid-only trial.”
5. Dr. Nisha S. Joseph: “For my patients diagnosed with high-risk smoldering multiple myeloma, I first talk about available clinical trials and then suggest Revlimid-only.”
6. Dr. Ola Landgren: “Fifteen percent to thirty-five percent of patients are lost at the end of each LOT (Line of Treatment).”
7. Dr. Nisha S. Joseph: “At Around 6 months, I taper my patients off dexamethasone.”
8. Dr. Luciano Costa: “B Cell maturation antigen (BCMA) occurs on all plasma cells, even the good ones.”
9. Dr. Luciano Costa: “Abecma versus Carvykti: Onset of cytokine release syndrome (CRS) is 1 day vs 7 days.”

Here is a link to the above symposium.

Symposium 3: Multiple Myeloma: Gauging Response of BiTEs and CAR-T in Aging Adults.

1. This symposium was part of a scientific session so it was mostly over my head. However, Dr. Francesco Maura discussed CAR-T/Bispecific relapse due to antigen loss. While he said this is true for GPRC5D, it is not the case for B cell maturation antigen (BCMA). Relapse on BCMA treatment is due, in part, to other antigens escaping and blocking treatment binding. A second cause is high levels of soluble BCMA (found in serum), which alters CAR-T activity.

Here is a link to the above symposium.

Symposium 4: Multiple Myeloma: Beyond the Guidelines: Clinical Investigator Perspectives on the Management of Myeloma Patients with the excellent panel Drs. Amrita Krishnan (AK), Sagar Lonial (SL), Robert Orlowski (RO), Noopur Raje (NR), and Paul Richardson (PR).

1. RO: “For a standard patient who achieves Complete Response (CR) from induction, and especially minimal residual disease (MRD), I encourage the patient to harvest stem cells, but I’m okay with them not going ahead with a transplant.”
2. SL: “Rumors of the demise of transplants are exaggerated.”
3. RO: “Sarclisa (isatuximab) may have better activity in 1q+ patients than Darzalex (daratumumab).”
4. NR: “Like many multiple myeloma drugs, they often get approved and then we figure out how to use them. This is the case with Blenrep.”
5. PR: “Xpovio (selinexor) plus venetoclax for t(11;14) patients is possible as long as supportive care (e.g. short-term follow-up visits) are available.
6. SL: “With CD38 mABs, we need to be more conscious of infections.”
7. SL: “A wearable bolus injector disc (looks like the end of a stethoscope) is used for subcutaneous isatuximab injection over 3-5 minutes.”
8. NK: “CAR T [therapy] waiting time has come down from 5 months last year to 2-3 months today.”
9. NR: “The CARTITUDE-6 study comparing CAR T therapy versus stem cell transplant (SCT) includes 2 yrs of Revlimid maintenance in both arms.”
10. SL: “BCMA BsAb and CAR T infections are profound because plasma cells are being wiped out.”
11. AK: “The neuropathy signal is real with BsAb Elranatamab.”
12. PR: “Celmods do not appear to have the same secondary primary risk as IMiD. Also very few grade 3/4 side effects.”

Here is a link to the above symposium.

So that’s it for tonight. My first meeting tomorrow — International Myeloma Working Group (IMWG) — is at 6:30 a.m. PST so it’s early to bed for tomorrow’s official Day 1 of ASH!

Be your own best patient advocate.

— Jack Aiello, on X (Twitter) @JackMAiello