Dr. Fallon on Supportive Care Considerations in R/R Multiple Myeloma

Michael J. Fallon, MD, radiation oncologist, University of Wisconsin Carbone Cancer Center, discusses supportive care considerations for patients with relapsed/refractory multiple myeloma.

The use of infection prophylaxis continues to evolve with the addition of new therapies, such as anti-BCMA CAR T-cell therapies and bispecific T-cell engagers, since these agents have different effects on the immune system that clinicians are still working to understand, Fallon says. Although the National Comprehensive Cancer Network guidelines have started to integrate the use of infection prophylaxis with these agents; however, the current recommendations only fit specific conditions for a patient, and more clarity is needed to know when this intervention is appropriate, Fallon explains. In the past, supportive care considerations for patients who received an autologous stem cell transplant were well defined, and improvements to guidelines will be made for newer therapies, according to Fallon, who adds that, in general, patients have less infections with T-cell redirecting therapies compared with other treatments.

Immunizations continue to be a cost burden to patients. For example, patients within the Medicare population are only allowed 2 lifetime doses of a pneumococcal injection, and patients with relapsed/refractory multiple myeloma will likely need up to 4 injections, Fallon explains. For patients who are post transplant, they may require up to 6 injections, and oftentimes, these patients will need to pay out of pocket for these vaccines, Fallon says.

Additionally, tertiary centers will provide some of these injections; however, patients must also rely on the local community hospitals and clinics to provide the injections, Fallon explains. Coordinating these series of vaccines between different health-care systems can also present a challenge for patients with multiple myeloma, Fallon adds.

Bone health remains the most impactful adverse event (AE) for patients with relapsed/refractory multiple myeloma, as they can experience walking difficulties, pain, and numbness, Fallon says. These AEs can be detrimental to a patient's quality of life. It is important that clinicians remain vigilant with medications to maintain bone health medications and ensure fractures do not happen, Fallon concludes.