Dr Chari on the Bridging the Gaps in Hematologic Malignancies Meeting

Ajai Chari, MD, director, Multiple Myeloma Program, professor of clinical medicine, University of California, San Francisco (UCSF), UCSF Helen Diller Family Comprehensive Cancer Center, discusses the 2024 OncLive® Bridging the Gaps in Hematologic Malignancies meeting, highlighting the topics that were covered at the meeting regarding the treatment of patients with multiple myeloma.

Chari quips that doctors who treat multiple myeloma often have differing views on how to approach various treatments across different settings. Thus, attending the meeting, he shares that he anticipated a lack of consensus on various topics. Although there were indeed areas where consensus was lacking, it was pleasantly surprising to find some unexpected points of agreement among the key opinion leaders present, Chari explains.

Beginning with discussions on newly diagnosed multiple myeloma, it was generally agreed that anti-CD38–based quadruplets are commonly utilized for induction therapy, with most clinicians favoring stem cell collection, he expands. The consensus also leaned toward recommending transplant, especially for patients deemed to have high-risk disease, with near unanimous agreement among attendees on this point, Chari states. For patients who are transplant-ineligible, there appeared to be clear consensus on the use of daratumumab (Darzalex), lenalidomide (Revlimid), and dexamethasone, possibly incorporating a proteasome inhibitor (PI) for select high-risk subgroups, he elucidates. 

However, significant controversy arose regarding post-transplant maintenance therapy, with lenalidomide being the most utilized agent, he continues. Disagreement centered on whether to incorporate daratumumab or a PI for high-risk patients and the optimal duration of daratumumab therapy, Chari reports. Additionally, in early relapse cases, there was a preference for anti-CD38 monoclonal antibodies based on data from the phase 3 IKEMA study (NCT03275285), he says. Furthermore, while most practitioners preferred switching treatment classes, concerns were raised about the suitability of carfilzomib (Kyprolis), particularly for elderly patients with cardiac comorbidities, Chari states

The meeting also highlighted considerable interest in early T-cell redirection with CAR T-cell therapies, along with ongoing discussions about effective sequencing strategies for bispecifics and CAR Ts, he explains. Moreover, there was apprehension regarding newer toxicities associated with some of these agents, such as motor dysfunction and cranial neuropathies, for which clinical experience remains limited, Chari concludes.