New guidelines for treatment of MM (EHA/ESMO)

Presenter S. Kastritis

Participation Spyridonidis, Liga, Tsokanas

Diagnostic obligatory are still Free light chain serum, 24-Urin, cytogenetics (Del17p, t(4,14), WBLD-CT and if  negative Whole body MRI.

Asymptomatic MM (use 20/2/20 score), if high (2 of 3) risk score these pats should be included in trials and receive therapy

First line treatment VRd, or DaraVTD, alternative VTD, VCD. Others DaraRD, DaraVMP, VRd, VMP, RD. KRd does not provide benefit and is toxic

Autologous (HD Mel 200, 140 in renal insufficiency) is still indicated

Consolidation, in high risk pts 2^nd ASCT or VRD, StaMIna study did not confirm

Maintenance standard of care, Lenalidomide, alternative, bortezomib/ ixazomib

1^st Relapse. If response to rescue therapy Autologous HSCT may provide benefit (German study)

Lenalidomide refractory/relapse Dara, Kd, Selinexor, in t11,14 venetoclax

Dara refractory relapse drugs are investigated

References

Ann Oncol. 2021 Mar;32(3):309-322. doi: 10.1016/j.annonc.2020.11.014. 

Hemasphere. 2021 Feb 3;5(2):e528