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Newly Diagnosed Multiple Myeloma

CE / CME

What’s New in Newly Diagnosed Multiple Myeloma

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurse Practitioners: 1.00 Nursing contact hours, includes 1.00 hour of pharmacotherapy credit

Released: May 16, 2024

Expiration: May 15, 2025

CME/CE Information

Activity

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Course Completed

Introduction

In this module, Charise Gleason, MSN, NP-C, AOCNP, discusses recent safety and efficacy data on multidrug regimens for the management of transplant-eligible and transplant-ineligible patients with newly diagnosed (ND) multiple myeloma (MM). She also provides guidance on managing key adverse events (AEs) with MM treatments.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. The question will be asked twice: once at the beginning of the activity and then once again after the discussion that informs the best choice. Your response will be aggregated for analysis, and your specific response will not be shared.

For those providing patient care, how many patients with MM do you provide care for in a typical month?

A 55-year-old woman with no significant past medical history presents with worsening lower back pain. Initial evaluation includes plain films that show multiple lytic lesions in the vertebrae with an associated compression fracture at L1. Initial labs are notable for hemoglobin 9.8 g/dL, albumin 3.1 g/dL, total protein 9.0 g/dL, serum creatine 0.8 g/dL, and calcium 11.0 mg/dL.


On additional evaluation, serum immunofixation/serum protein electrophoresis shows IgA lambda monoclonal protein of 3.5 g/dL. IgG is 400, IgA 3700, IgM 20, kappa 5.1 mg/L, lambda 267 mg/L, and free light chain (FLC) ratio 0.019. Lactate dehydrogenase (LDH) is elevated at 400 IU/L; serum β2-microglobulin is 7.1 mg/L, and PET/CT scan shows multiple hypermetabolic areas in the bones with associated lytic lesions. Bone marrow biopsy results show 45% atypical plasma cells; FISH (CD138+ selected) analysis shows gain 1q positive and t(4;14).

What induction therapy would you recommend for this patient?

In the phase III IsKia EMN24 trial that enrolled transplant-eligible patients with NDMM, which of the following was reported with isatuximab/carfilzomib/lenalidomide/dexamethasone (IsaKRd) vs carfilzomib/lenalidomide/dexamethasone (KRd)?

An 81-year-old man with a history of type 2 diabetes, hypertension, coronary artery disease status post CABG 4 years ago is widowed and lives alone. He presented to an oncologist after his primary care physician obtained routine labs that showed hemoglobin 10.0 g/dL, elevated total serum protein (10.4 g/dL), albumin 3.1 g/dL, normal calcium, and serum creatinine 1.3 g/dL (1.0 g/dL 1 year prior).


Upon additional evaluation, serum immunofixation/serum protein electrophoresis reveals IgG kappa monoclonal protein 4.5 g/dL.  IgG is 4800, IgA 23, IgM 20, kappa 720 mg/L, lambda 3.4 mg/L, FLC ratio 212. Serum LDH is normal and serum β2-microglobulin is 4.1 mg/L. Low-dose whole-body CT scan shows multiple lytic bone lesions. Bone marrow biopsy shows 70% atypical plasma cells, and FISH (CD138+ selected) reveals trisomies involving chromosomes 3, 7, 9, and 11 but no IgH translocations, del(17p), or gain 1q.

What therapy would you recommend for this patient?

For a patient with NDMM receiving a quadruple-drug regimen with Dara-VRd who develops a deep vein thrombosis (DVT) despite adhering to a daily 81 mg aspirin regimen, what would be the most appropriate thromboprophylaxis strategy moving forward?

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