Derek C. Galligan, MD, a medical oncologist at the Center for Health & Healing Building, Oregon Health & Science University, discusses unmet needs in high-risk multiple myeloma.

 Despite positive ​results from several clinical trials, including the ​phase 2 GRIFFIN study, it's unclear whether ​patients with high-risk cytogenetics derive more benefit from quadruplet or triplet therapy​ up front, says Galligan.

Given that no randomized data have pointed to the optimal approach, single-arm studies continue to use triplet induction, transplant, and dose-reduced maintenance, with bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone ​or carfilzomib (Kyprolis), lenalidomide, and dexamethasone, in younger patients and those with high-risk ​disease, Galligan says.

Moreover, ongoing trials are actively recruiting high-risk patients to evaluate the potential efficacy of novel drugs, such aselotuzumab (Empliciti), Galligan concludes.

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Derek C. Galligan, MD, discusses unmet needs in high-risk multiple myeloma.

Dr. Galligan on Unmet Needs in High-Risk Multiple Myeloma 

Derek C. Galligan, MD, a medical oncologist at the Center for Health & Healing Building, Oregon Health & Science University, discusses transplant eligibility in determining subsequent treatment for patients with multiple myeloma.

For most patients, standard therapy consists of a triplet regimen of lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (RVd), which is a bit agnostic in terms of whether or not a patient is going to receive a transplant, says Galligan. Regardless of future treatments, RVd is often the regimen to start with, Galligan adds.

Even so, understanding if the patient is a candidate for transplant early on in the course of their disease is important, as it can impact the number of cycles of therapy they will receive, Galligan explains. For example, as patients receive more lenalidomide, it becomes harder to collect stem cells. This decision should be made early on, although it is not critical to determine whether patients will undergo transplant when they first begin treatment, concludes Galligan.

Derek C. Galligan, MD, discusses transplant eligibility in determining subsequent treatment for patients with multiple myeloma.

Dr. Galligan on Transplant Eligibility and Subsequent Treatments in Multiple Myeloma

Derek C. Galligan, MD, medical oncologist, Center for Health & Healing Building, Oregon Health & Science University, discusses the utility of up-front high-intensity therapy for patients with multiple myeloma. 

In general, patients with newly diagnosed multiple myeloma have low symptom burden and can wait a short period of time before initiating therapy, Galligan says.

However, some patients with myeloma present with renal failure, hyperviscosity syndrome, or extensive bone disease, says Galligan. In these cases, patients require immediate inpatient treatment.

One high-intensity option is modified hyper-CVAD [cyclophosphamide, vincristine, doxorubicin, and dexamethasone] with or without proteasome inhibitors, says Galligan. Modified hyper-CVAD plus best supportive care has been shown to help control disease and reverse organ damage.

Moreover, some patients can come off dialysis with the regimen, concludes Galligan.

Derek C. Galligan, MD, discusses the utility of up-front high-intensity therapy for patients with multiple myeloma. 










Derek C. Galligan, MD

Articles

Dr. Galligan on Unmet Needs in High-Risk Multiple Myeloma

Dr. Galligan on Transplant Eligibility and Subsequent Treatments in Multiple Myeloma

Dr. Galligan the Utility of Up-front High-Intensity Therapy in Multiple Myeloma