Standard of Care in Newly Diagnosed Myeloma

Shaji Kumar, MD, a hematologist at the Mayo Clinic and chair of the Plasma Cell Disorders Scientific Committee at the American Society of Hematology, discuses the standard of care in newly diagnosed myeloma.

According to Kumar, the standard of care is currently a proteasome inhibitor in combination with immunomodulatory drugs or monoclonal antibodies. For patients who are transplant-eligible, induction therapy with dexamethasone is used prior to a single transplant. After the transplant, patients received lenalidomide maintenance (Revlimid). If that patient is high-risk, daratumumab (Darzalex) plus bortezomib, lenalidomide, dexamethasone (VRd) is used.

If the patient is ineligible for transplant, daratumumab is used until disease progression. For high-risk disease, VRd light is used with an effort to also use a proteasome inhibitor or other immunomodulatory drug.

0:08 | The current treatments that we use for newly diagnosed myeloma, are essentially combinations of proteasome inhibitors, immunomodulatory drugs or monoclonal antibodies. Patients who are eligible for a stem cell transplant often get induction therapy with dexamethasone, has a single transplant and goes on lenalidomide maintenance. If they are high risk, we try to use 4 drug combinations, including daratumumab plus VRd, then onto single or 2 transplants and then to drug maintenance therapy. Non transplant eligible patients get started with daratumumab and often continue on therapy until progression. In people with high risk disease, we tend to use VRd light, but typically try to get a proteasome inhibitor and immunomodulatory drug in there.