Alessandra Larocca, MD, PhD, hematologist, Division of Hematology, University of Torino, Azienda Ospedaliero‐Universitaria Città della Salute e della Scienza di Torino, Italy, discusses recent advancements in relapsed/refractory multiple myeloma.

The introduction of immunotherapy and anti-CD38 monoclonal antibodies have been practice-changing innovations for the elderly relapsed/refractory multiple myeloma patient population, and more monoclonal antibodies are under investigation, Larocca says. These treatments are tolerable in frail patients, and they have achieved improved outcomes in older patients, Larocca explains.

Identifying treatments that do not require a dose adjustment can be a challenge for patients with relapsed/refractory multiple myeloma who present with renal failure, Larocca adds. However, monoclonal antibodies do not need a dose adjustment, making them safer for patients with renal impairment, Larocca says.

Data from clinical trials may be limited for the subgroup of difficult-to-treat patients, making it more difficult to inform treatment decisions, Larocca says. However, it is still helpful to consult these data, in addition to what is seen in clinical practice, Larocca concludes.

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Alessandra Larocca, MD, PhD, discusses recent advancements in relapsed/refractory multiple myeloma.


Dr. Larocca on Recent Advancements in R/R Multiple Myeloma

Alessandra Larocca, MD, PhD, hematologist, Division of Hematology, University of Torino, Azienda Ospedaliero‐Universitaria Città della Salute e della Scienza di Torino, Italy, discusses the diagnosis and management of difficult-to-treat patients with multiple myeloma.

Different factors contribute to the prognosis in this patient population, Larocca says. Difficult-to-treat patients may present with high-risk characteristics, such as chromosomal abnormalities, or aggressive disease seen in the form of plasma cell leukemia, extra medullary disease, or an early relapse, Larocca explains. Moreover, patient-related factors, including age, frailty status, comorbidities, functional impairments, and organ function, can impact these patients, Larocca adds.

Patient frailty scores are typically established at diagnosis, and there is no standard assessment for frailty for patients with relapsed/refractory multiple myeloma, Larocca explains. Examining a patient’s comorbidities, functional status, independence, and social support can all play a role in treatment decisions, Larocca explains.

Defining the frailty status of a patient at diagnosis can be helpful at relapse to help provide a more objective measure of a patient’s prognosis, and optimal treatment choices can stem from this information, Larocca concludes.

Alessandra Larocca, MD, PhD, discusses the diagnosis and management of difficult-to-treat patients with multiple myeloma.

Dr. Larocca on the Management of Difficult-to-Treat Patients in Multiple Myeloma

Alessandra Larocca, MD, PhD, hematologist, Division of Hematology, University of Torino, Azienda Ospedaliero‐Universitaria Città della Salute e della Scienza di Torino, Italy, discusses what to know when diagnosing difficult-to-treat patients with multiple myeloma.

The prognosis for a patient with multiple myeloma can be defined by several factors, Larocca says. Patients could be categorized as difficult-to-treat for a variety of reasons, including the presence of high-risk chromosomal abnormalities or presentation with an aggressive disease, such as plasma cell leukemia or extramedullary disease, Larocca explains.

Patient-related factors can also play a role in the prognosis, Larocca continues. Age, frailty status, the presence of comorbidities, functional impairments, and organ function can all contribute in an individual patient’s prognosis, Larocca concludes.

Alessandra Larocca, MD, PhD, discusses what to know when diagnosing difficult-to-treat patients with multiple myeloma. 


Dr. Larocca on What to Know when Diagnosing Difficult-to-Treat Patients in Multiple Myeloma

Alessandra Larocca, MD, PhD, hematologist, Division of Hematology, University of Torino, Azienda Ospedaliero‐Universitaria Città della Salute e della Scienza di Torino, Italy, discusses the various factors to consider when selecting treatment for difficult-to-treat patients with relapsed/refractory multiple myeloma.

The treatment history of an individual patient and certain disease characteristics must be considered when selecting an optimal treatment plan for a patient; this can be particularly difficult in the relapsed/refractory setting, according to Larocca. Key considerations include response to prior therapy, sensitivity of disease, previous toxicities, the presence of comorbidities, performance status, social support, and other patient variables, Larocca explains.

It is also important to take biological factors like the presence of chromosomal abnormalities and aggressiveness of the disease, such as extramedullary disease, renal insufficiency, and the presence of plasma cells in the peripheral blood, into account when making clinical decisions, Larocca concludes. 

Alessandra Larocca, MD, PhD, discusses the various factors to consider when selecting treatment for difficult-to-treat patients with relapsed/refractory multiple myeloma.

Alessandra Larocca, MD, PhD

Articles

Dr. Larocca on Recent Advancements in R/R Multiple Myeloma

Dr. Larocca on the Management of Difficult-to-Treat Patients in Multiple Myeloma

Dr. Larocca on What to Know when Diagnosing Difficult-to-Treat Patients in Multiple Myeloma

Dr. Larocca on Treatment Considerations for Difficult-to-Treat, Relapsed/Refractory Myeloma