Dr. Berdeja on Treatment of Patients With Newly Diagnosed Myeloma

Jesus Berdeja, MD, director of Multiple Myeloma Research at Sarah Cannon Research Institute, discusses the treatment of patients with newly diagnosed myeloma.

This is a field that is exploding with new treatment options, Berdeja says, with several effective therapies in the relapsed/refractory setting being investigated upfront. However, physicians are faced with the ongoing challenge of deciding how to best use and sequence these treatments. When patients are initially diagnosed with myeloma, physicians must determine whether they are candidates for autologous stem cell transplant (ASCT) or not, and that has been a difficult question to answer, says Berdeja.

In the transplant-ineligible patient population, past treatment options were relatively poor because researchers felt this was a frail group of patients that could not handle aggressive therapy. However, physicians are now seeing a shift toward the use of a combination therapy approach in these patients as opposed to treatment with a standard doublet.

Data from the 2018 ASH Annual Meeting and other recent conferences, have suggested that traditional regimens like bortezomib (Velcade), melphalan, and prednisone, or the lenalidomide plus dexamethasone doublet, are perhaps not the best treatment option for these patients. However, the incorporation of monoclonal antibodies like daratumumab (Darzalex) has been shown to boost the efficacy of these regimens with very little added toxicity.