This content is for healthcare professionals only.

This activity is funded by an independent medical education grant from Bristol Myers Squibb.

This activity is jointly provided by USF Health and touchIME.

Faculty & Disclosures

Listen on the go

    • View and download resources from this activity to support your learning and share with colleagues

    Download Slides
    CORRECT!
    Next question
    Faculty & Disclosures
    Dr Sarah Holstein

    University of Nebraska Medical Center, Omaha, NE, USA

    Dr Holstein, MD, PhD, is a professor in the Division of Oncology and Hematology at the University of Nebraska Medical Center, Omaha, NE, USA. She is the team leader of the Myeloma/Plasma Cell Dyscrasia Group at the Fred and Pamela Buffett Cancer Center. Dr Holstein previously served as a myeloma specialist at the University of Iowa and the Roswell Park Comprehensive Cancer Center, New York, USA. She is a physician-scientist, whose basic science, translational and clinical research focuses on myeloma. read more

    Dr Holstein serves on multiple national myeloma committees and is a member of the International Myeloma Working Group. She has published more than 100 peer-reviewed articles and multiple book chapters. She serves as an associate editor for Clinical Pharmacology & Therapeutics, as well as the British Journal of Haematology.

    Dr Sarah Holstein discloses: Consultancy fees from AbbVie, Bristol Myers Squibb, Janssen Pharmaceuticals, Oncopeptides, Secura Bio and Takeda Pharmaceutical (relationships terminated); Grants/research support from Bristol Myers Squibb and Oncopeptides (relationships terminated).
    Dr Nikhil Munshi

    Dana-Farber Cancer Institute,
    Boston, MA, USA

    Dr. Munshi, MD, is professor of medicine at Harvard Medical School, as well as the endowed Kraft Family Chair, director of basic and correlative science and associate director of the Jerome Lipper Myeloma Center at Dana-Farber Cancer Institute. He is a senior physician at the Brigham and Women’s Hospital and the Boston VA Healthcare System. Dr Munshi received his medical degree from the SSG Hospital and MS University, Baroda, India. He completed a research fellowship in medical oncology at the Johns Hopkins Oncology Center in Baltimore, MA, USA and a clinical fellowship in haematology/oncology at the Indiana University Medical Center, IN, USA. read more

    Dr Munshi’s research has aimed to understand genomic changes in myeloma, elucidate molecular mechanisms driving the genomic instability in cancer, and improve diagnosis, prognosis and therapeutics. His current research centres on integrative oncogenomics in myeloma and developing novel targeted therapeutics including antigen-directed and immune effector cell therapy/vaccine approaches.

    Dr Munshi has over 500 peer-reviewed publications and has mentored over 70 junior faculty, post-doctoral fellows, and students. Dr Munshi is the president of the International Myeloma Society and an associate editor for Blood Advances. He has received several awards, including the prestigious Waldenström Lifetime Achievement Award for his contribution to myeloma research and the Dr BC Roy National Award by the president of India.

    Dr Nikhil Munshi discloses: Consultancy fees from Amgen, Bristol Myers Squibb, Janssen Pharmaceuticals, Legend Biotech, Novartis, OncoPep, Pfizer and Takeda Pharmaceutical (all relationships terminated); Stock/shareholder (self-managed) OncoPep.
    Dr Noopur Raje

    Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Dr Raje is a professor of medicine at Harvard Medical School, the director of the Center for Multiple Myeloma and the Rita Kelley Chair in Oncology at the Massachusetts General Hospital Cancer Center. She is a physician scientist with a primary focus on multiple myeloma and related plasma cell disorders. read more

    Dr Raje has focused on developing new promising therapies for multiple myeloma. Her laboratory efforts are aimed at identifying cellular signalling pathways that contribute to the survival and proliferation of myeloma cells in the bone environment, and designing trials to specifically harness these. She is the co-chair of the National Cancer Institute steering committee for multiple myeloma and a board member of the International Myeloma Society.

    Dr Noopur Raje discloses: Advisory board or panel fees from Caribou Biosciences and Immuneel Therapeutics; Consultancy fees from AbbVie, Amgen, Bristol Myers Squibb, Pfizer, Sanofi and Takeda Pharmaceutical; Grants/research support from Bluebird Bio.
    Back to Faculty
    touchONCOLOGY touchONCOLOGY
    Start activity
     
    Videos Take CE/CME Test
    Haematological Malignancies, Haematology, Multiple Myeloma CE/CME accredited

    touchPANEL DISCUSSION
    A visually engaging discussion designed to emulate a ‘live’ panel experience and provide clinicians with practical expert insights to address their clinical challenges. Useful tips below will show how to navigate the activity. Close

    Key considerations for treatment selection and sequencing in patients with RRMM: Lessons from real-life clinical practice

    Faculty Podcast Featured
    Useful tips
    • Downloads including slides are available for this activity in the Toolkit
    Learning Objectives

    After watching this activity, participants should be better able to:

    • Interpret factors that must be balanced when choosing therapy for patients with RRMM who have relapsed following 1–3 prior lines of therapy
    • Evaluate alternative treatment strategies for patients with RRMM following >3 prior lines of therapy
    • Identify optimal sequencing strategies for patients with RRMM in both early- and later-line settings
    Overview

    In this case-based activity, three leading experts discuss treatment decision making in patients with RRMM, both in the earlier-line and later-line settings, and how to approach treatment sequencing in an evolving landscape.

    This activity is jointly provided by USF Health and touchIME. read more

    Target Audience

    This activity has been designed to meet the educational needs of haematologists and oncologists, including haemato-oncologist specialists, involved in the management of RRMM.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Sarah Holstein discloses: Consultancy fees from AbbVie, Bristol Myers Squibb, Janssen Pharmaceuticals, Oncopeptides, Secura Bio and Takeda Pharmaceutical (relationships terminated); Grants/research support from Bristol Myers Squibb and Oncopeptides (relationships terminated).

    Dr Nikhil Munshi discloses: Consultancy fees from Amgen, Bristol Myers Squibb, Janssen Pharmaceuticals, Legend Biotech, Novartis, OncoPep, Pfizer and Takeda Pharmaceutical (all relationships terminated); Stock/shareholder (self-managed) OncoPep.

    Dr Noopur Raje discloses: Advisory board or panel fees from Caribou Biosciences and Immuneel Therapeutics; Consultancy fees from AbbVie, Amgen, Bristol Myers Squibb, Pfizer, Sanofi and Takeda Pharmaceutical; Grants/research support from Bluebird Bio.

    Content reviewer

    Alicia Canalejo, MSN, APRN-C has no relevant financial relationships to disclose.

    Touch Medical Directors

    Holly Gilbert-Jones has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu.

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 21 June 2023. Date credits expire: 21 June 2024.

    If you have any questions regarding credit please contact cpdsupport@usf.edu.

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

    Claim Credit
    Useful tips
    • Downloads including slides are available for this activity in the Toolkit

    You may also be interested in...

    touchPANEL DISCUSSION

    Maximizing the possibilities in the evolving treatment paradigm for R/R follicular lymphoma: From optimal sequencing to shared decision-making

    This activity is CE/CME accredited
    LAUNCH ACTIVITY

    touchPANEL DISCUSSION

    CAR-T in clinical practice: Navigating the patient journey from referral to long-term follow-up

    LAUNCH ACTIVITY

    CONFERENCE HUB

    Paolo Ghia, EHA 2019 – ASCEND Phase III Study

    GO TO HUB
    Thumbnails_Gertz.png

    CONFERENCE HUB

    Morie A Gertz, ASH 2018 – Hereditary TTR Amyloidosis and the NEURO-TTR Study

    GO TO HUB

    JOURNALS

    Current Status of Maintenance Therapy in Multiple Myeloma

    GO TO ARTICLE

    JOURNALS

    Venous Thromboembolism – The Intersection of Thrombosis and Inflammation

    GO TO ARTICLE

    Topics covered in this activity

    Haematological Malignancies / Haematology / Multiple Myeloma
    REGISTER NOW FOR FREE ACCESS TO
    • 1000+ topical and insightful peer-reviewed journal articles
    • 100+ hours of bite-sized congress highlights
    • 9 major therapy areas packed with the latest scientific advances
    • 150+ specialties offering learn-on-the-go medical education
    • + Concise email updates and newsletters so you never miss out
    Register For Free Now
    This Activity is Funded By:

    An independent medical education grant from Bristol Myers Squibb.
    This activity is jointly provided by USF Health and touchIME.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME activities. touchIME accepts no responsibility for errors or omissions.

    This content is intended only for healthcare professionals.

    Date of original release: 21 June 2023. Date credits expire: 21 June 2024.

    Claim Credit
    touchPANEL DISCUSSION
    Key considerations for treatment selection and sequencing in patients with RRMM: Lessons from real-life clinical practice
    0.75 CE/CME credit
    Question 1/5
    Which of the following factors should be considered first, when choosing a treatment strategy for patients with RRMM who have relapsed following 1 to ≤3 lines of therapy?

    RRMM, relapsed/refractory multiple myeloma.

    Treatment selection for patients with RRMM is challenging and the optimal sequence and choice of drugs is not established. Treatment-related factors, such as type and response to prior therapy, are critical for the selection of a new treatment regimen; it also depends on a range of patient- and tumour-related factors.1 

    Abbreviation

    RRMM, relapsed/refractory multiple myeloma.

    Reference

    van de Donk, NWCJ. Hematology Am Soc Hematol Educ Program. 2020;2020:248–58.

    Question 2/5
    You are treating a frail 81-year-old woman with RRMM, hypertension and renal insufficiency. Her disease has high-risk features (bone marrow; 60% with t[4;14]) and she relapsed early on her previous two lines of therapy (VCd followed by Dara-Rd). Which of the following treatment strategies would you adopt now?

    C, cyclophosphamide; d, dexamethasone; Dara, daratumumab; Elo, elotuzumab; Isa, isatuximab; K, carfilzomib; P, pomalidomide; R, lenalidomide; RRMM, relapsed/refractory multiple myeloma; V, bortezomib.

    A triplet therapy is preferred over dual therapy, since there is evidence that frail patients may have improved outcomes with triplet vs dual therapies; although they are also at higher risk from toxicities vs fit patients.1 There is insufficient evidence to support retreatment with an alternative anti-CD38 mAb such as Isa in anti-CD38 mAb refractory patients.2 There is evidence of increased risk of renal failure with K.3

    Abbreviations

    Isa, isatuximab; K, carfilzomib; mAb, monoclonal antibody.

    References

    1. Mian H, et al. Blood Cancer J. 2023;13:6.
    2. van de Donk, NWCJ. Hematology Am Soc Hematol Educ Program. 2020;2020:248–58.
    3. Mian HS, et al. Ann Hematol. 2021;100:1261–6.
    Question 3/5
    You are treating a patient with the CAR T-cell therapy, ide-cel, and she asks you what her prognosis is likely to be with the treatment. What do you tell her you will expect to see, using MRD negativity as an indicator for prognosis?

    CAR, chimeric antigen receptor; ide-cel, idecabtagene vicleucel; MRD, minimal residual disease.

    A systematic review highlighted the strong prognostic value of MRD negativity and confirmed its utility as a surrogate for PFS and OS in MM.1 Subsequently, an analysis of data from the POLLUX (Dara-Rd) and CASTOR (Dara-Vd) trials showed that sustained MRD negativity for ≥6 and ≥12 months  was associated with prolonged PFS.2

    From available data for CAR T-cell therapies, a deep initial response, while necessary, is not sufficient for long-term remission.3 Data  from the phase Ib/II CARTITUDE-1 trial further indicates the benefit of sustained MRD negativity. At 27 months’ follow-up, in patients who achieved sustained MRD negativity for ≥6 and ≥12 months, PFS rates were 73.0% and 78.8%; OS rates were 93.5% and 90.8%. Respective values in the overall population were 54.9% and 70.4%.4

    Abbreviations

    CAR, chimeric antigen receptor; d, dexamethasone; Dara, daratumumab; MM, multiple myeloma; MRD, minimal residual disease; OS, overall survival; PFS, progression-free survival; R, lenalidomide; V, bortezomib.

    References

    1. Munshi N, et al. Blood Adv. 2020;4:5988–99.
    2. Avet-Loiseau H, et al. J Clin Oncol. 2021;39:1139–49.
    3. Cappell KM, Kochenderfer JN. Nat Rev Clin Oncol. 2023;20:359–71.
    4. Martin T, et al. J Clin Oncol. 2023;41:1265–74.
    Question 4/5
    What is one reason why sequencing CAR T cells in the earlier line setting may be optimal?

    CAR, chimeric antigen receptor.

    Early data for CAR T cells manufactured after response to induction therapy suggested they may be more clinically effective than those obtained from heavily treated RRMM patients, leading potentially to more durable responses to therapy.1

    Subsequent data from the KarMMa-3 trial demonstrated how treatment with idecabtagene vicleucel significantly prolonged median PFS vs standard regimens in patients with triple-class–exposed RRMM (13.3 vs 4.4 months, p<0.001).2

    Abbreviations

    CAR, chimeric antigen receptor; PFS, progression-free survival; RRMM, relapsed/refractory multiple myeloma.

    References

    1. Garfall AL, et al. Blood Adv. 2019;3:2812–5.
    2. Rodriguez‑Otero P, et al. N Engl J Med. 2023;388:1002–14.
    Question 5/5
    In patients treated in the later line, which of the following treatment sequences would you preferentially choose to optimize outcomes, based on available data?

    ADC, antibody–drug conjugate; BsAb, bispecific antibody; CAR, chimeric antigen receptor.

    Evidence indicates that patients can be successfully treated with a BsAb following CAR T-cell therapy,1 and that earlier referral for CAR T-cell therapy increases the likelihood of successful infusion.2

    The ADC belantamab mafodotin-blmf is not currently approved for use, although NCCN guidelines state that it can be useful in certain circumstances, if available through a compassionate use programme.3

    Alkylating drugs like bendamustine reduce the number and function of T cells, potentially reducing the efficacy of subsequent BsAb or CAR T-cell therapy.4 

    Abbreviations

    BsAb, bispecific antibody; CAR, chimeric antigen receptor; NCCN, National Comprehensive Cancer Network.

    References

    1. Touzeau C, et al. HemaSphere. 2022;6:85–6.
    2. Cohen AD, et al. Blood. 2023;141:219–30.
    3. NCCN. Multiple myeloma. Version 3.2023. Available at: www.nccn.org/login?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf (accessed 31 May 2023).
    4. van de Donk, NWCJ. Hematology Am Soc Hematol Educ Program. 2020;2020:248–58.
    Back to Activity

    You may also be interested in...

    CONFERENCE HUB

    Shaji Kumar, ASH 2022: Updated efficacy analysis from the phase III MAIA study in newly-diagnosed multiple myeloma

    GO TO HUB

    touchEXPERT OPINIONS

    Getting personal: Individualizing therapy for cold agglutinin disease

    This activity is CE/CME accredited
    LAUNCH ACTIVITY

    touchPANEL DISCUSSION

    Understanding the immunopathogenesis of CAD: What are the implications of new and emerging therapies?

    This activity is CE/CME accredited
    LAUNCH ACTIVITY

    CONFERENCE HUB

    Antonis Kattamis, EHA 2019 – Transfusion-dependent Thalassemia and the DEEP-2 Trial

    GO TO HUB

    JOURNALS

    Thalassaemia as a Hypercoagulable State

    GO TO ARTICLE

    JOURNALS

    Long-term Prophylaxis in von Willebrand Disease – How Should It Be Given and for Whom?

    GO TO ARTICLE
    This Activity is Funded By:

    An independent medical education grant from Bristol Myers Squibb.
    This activity is jointly provided by USF Health and touchIME.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME activities. touchIME accepts no responsibility for errors or omissions.

    This content is intended only for healthcare professionals.

    Date of original release: 21 June 2023. Date credits expire: 21 June 2024.

    Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72