Innovative Research in Myeloma Treatment: Insights From Dr. Siegel

David Samuel Dicapua Siegel, MD, chief, Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, shared his perspectives on promising areas of research that could advance the care of patients with myeloma.

Siegel highlights the complexities of maintenance therapy with lenalidomide (Revlimid). While effective, lenalidomide is not without its drawbacks. Financially, it poses a significant burden, and regarding safety, its toxicity profile can be concerning with the increased risk of secondary malignancies. Further, the agent can induce myelosuppression, which can harm bone marrow when used over extended periods, and can potentially affect one's ability to tolerate other therapies in the future.

As a result, Siegel believes re-evaluating the routine use of maintenance lenalidomide is crucial.

Siegel also discusses the interesting area of research looking at the role of single and tandem stem cell transplantation. Despite being some of the least expensive interventions available, these methods have shown remarkable efficacy. He adds in his skepticism about chimeric antigen receptor (CAR) T-cell therapy entirely replacing stem cell transplantation. Although CAR T-cell therapy is a groundbreaking advancement, its long-term outcomes are still under evaluation.

Transcription:

0:09 | Perhaps, maintenance lenalidomide is not a given. It is expensive, I mean, financially, it is expensive. It is expensive toxicity wise, increases the risk of second malignancies, it is myelosuppressive, [it] may injure the marrow when used chronically in ways that have bearing on future tolerability of other therapies. So I think that that is very interesting.

0:42 | I think the data about single and tandem transplantation is also very interesting. These are 2 very inexpensive modalities, probably the cheapest intervention that we have. And as the cost of care goes up, considering the role of stem cell transplant moving into the future is a very important one. I am not necessarily convinced that CAR T cells should be replacing stem cell transplantation. Still the only therapy that we have ever entertained, that has documented remissions that are measured in decades.