Dr. Jagannath on Treatment Advances in Transplant-Ineligible Patients With Myeloma

Sundar Jagannath, MD, director of the Multiple Myeloma program and professor of medicine at the Tisch Cancer Institute, Mount Sinai Health System, discusses the progress that has been made in transplant-ineligible patients with multiple myeloma.

Patients who are not eligible for transplant are often elderly and frail patients over the age of 75 or 80 with renal impairment and comorbidities. With immunotherapy and other novel therapies, physicians are able to safely give combination therapy to these patients, says Jagannath, an approach that results in meaningful remissions.

The second notable advance in this setting is the ability to look for minimal residual disease (MRD) in the bone marrow. Now, more patients are going into complete remission or stringent complete remission—both biochemical remissions—as well as demonstrating morphologically negative bone marrow, adds Jagannath. Physicians can use several modalities to test for MRD, including flow cytometry and next-generation sequencing. Based on residual disease, physicians are able to predict whether or not a patient is likely to sustain their remission.