Game-Changing Strategies for Early-Relapsed Myeloma

Joseph Mikhael, MD, MEd, FRCPC, FACP, is chief medical officer of the International Myeloma Foundation; professor at the Translational Genomics Research Institute in Phoenix, part of the City of Hope system; and director the myeloma program and research program at the HonorHealth Research Institute in Scottsdale, Arizona. He also leads the M-POWER Program, which investigates outcomes in multiple myeloma (MM) primarily among African Americans and Latino Americans.

In this final part of our interview with him from the European Hematology Association 2024 Congress, he addresses how despite treatment advancements as of late, patients who experience an early relapse of their disease are predisposed to worse outcomes, as well as promising strategies to increase their chances of putting the brakes on disease progression.

This transcript has been lightly edited for clarity.

Transcript

What unmet medical needs exist among patients with early-relapsed MM, and what are some strategies to address them?

There really are still many unmet medical needs in myeloma. One of them, despite the plethora of trials that have been done and the options that we have, it really does exist in early relapse. And for us, although we see these great frontline strategies now with quadruplets, with or without transplant, maybe even now incorporating CAR T [chimeric antigen receptor T-cell therapy] up front, inevitably, there are a fraction of patients who relapse quite quickly. We sometimes call this functional high risk—whether they have [high-risk] cytogenetics or not—those patients relapse quickly within 1 or perhaps 1.5 years of their transplant or of their initial therapy. We know unequivocally and historically that those patients will have, generally speaking, a terrible outcome, that with each remission, the time in remission shortens, so if that first one is so short, it's inevitable that it will become shorter.

That's where we have a particular unmet need, and I think that's where, for example, now we're prioritizing our CAR T-cell patients, that we have access to CAR T and those earlier lines of therapy, that this may be of benefit to them. We've seen some data presented recently that seem to support better outcomes in those patients when we introduced CAR T earlier. But it still remains a challenge.

The other unmet need that I'm just going to add in as sort of a bonus unmet need is really almost even independent of the time in which someone relapses, are that small—and thankfully it is getting smaller—fraction of patients who experience very significant toxicities from what they've had before. In particular, those who may have significant neuropathy. So we want to do all that we can up front to minimize that so that when those occur, we can have the best strategy to prevent them, reduce them, and, hopefully, minimize them as patients may experience it.