Tomer Mark, MD, clinical director, Plasma Cell Disorders Program, University of Colorado Health, discusses making sequencing decisions amid the array of available treatment options in multiple myeloma.

When looking at sequencing treatment options, the field has more to learn, particularly as it relates to managing toxicities, Mark says. As clinicians continue to gather more data emerge, treatment-related toxicities are becoming more predictable and are able to be better managed, Mark explains. However, patients are still required to stay in the hospital for 2 weeks after receiving CAR T-cell therapy because of the unknown outcomes and potential risks, Mark adds. Overall, there is just more experience is needed with these agents, Mark says.

Moreover, it is likely that CAR T-cell therapy specifically will become part of standard treatment in the future. Similar to autologous stem cell transplant, CAR T-cell therapy requires planning with the patient, Mark continues. As such, CAR T-cell therapy may be mostly utilized as a minimal residual disease–guided, elective treatment rather than a rescue treatment for patients with multiple myeloma, Mark concludes. 

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Tomer Mark, MD, discusses making sequencing decisions amid the array of available treatment options in multiple myeloma. 

Dr. Mark on ​Questions Regarding Sequencing in Multiple Myeloma 

Tomer Mark, MD, clinical director, Plasma Cell Disorders Program, University of Colorado Health, discusses establishing minimal residual disease (MRD) as a surrogate marker for survival in multiple myeloma.

Although MRD is not universally accepted as a surrogate marker for survival, it is being incorporated into numerous clinical trials and may represent an improved marker compared with International Myeloma Working Group criteria, Mark says. 

Additionally, more patients are achieving MRD negativity status, Mark explains. This is true even in the relapsed/refractory setting, with the advent of CAR T-cell therapies, such as idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel; these products are associated with a MRD-negativity rate of around 50%. 

Other regimens leveraging monoclonal antibodies, such as the combination of daratumumab (Darzalex), lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone, are also demonstrating continued MRD negativity in patients with newly diagnosed multiple myeloma, Mark says. However, although certain approaches are inducing deep and durable responses in patients, questions regarding the optimal sequencing of therapy remain unanswered, Mark concludes. 

Tomer Mark, MD, discusses establishing minimal residual disease (MRD) as a surrogate marker for survival in multiple myeloma.  



Tomer Mark, MD

Articles

Dr. Mark on Questions Regarding Sequencing in Multiple Myeloma

Dr. Mark on Establishing MRD as a Surrogate Marker for Survival in Multiple Myeloma

Tomer Mark, MD

Articles

Dr. Mark on ​Questions Regarding Sequencing in Multiple Myeloma

Dr. Mark on Establishing MRD as a Surrogate Marker for Survival in Multiple Myeloma

Dr. Mark on Questions Regarding Sequencing in Multiple Myeloma