Exploring the Current Treatment Landscape for Patients With Extramedullary MM

At the 2024 Lymphoma, Leukemia & Myeloma (LL&M) Congress in New York, New York, Saad Usmani, MD, Memorial Sloan Kettering Cancer Center, New York, New York, discusses the current treatment landscape for patients with extramedullary multiple myeloma, specifically utilizing quadruplet induction with or without transplant followed by a 2-drug maintenance strategy.

“I made the case that utilizing quadruplet induction with or without transplant followed by [a] 2-drug maintenance strategy, either with proteasome inhibitors (PIs) [and] immunomodulatory drugs (IMiDs) or with daratumumab and [the] IMiD such as lenalidomide may make more sense,” said Dr Usmani.

Transcript:

Hello, my name is Saad Usmani. I am the chief of the myeloma service at Memorial Sloan Kettering Cancer Center, and it was a privilege to speak at the LL&M meeting in New York.

The topic assigned to me was whether we have anything new or promising in extramedullary multiple myeloma [research]. [During] part of my talk, I highlighted the clinical phenotype of extramedullary disease as well as the biologic features that this subset may have.

It's important to appreciate that even in today's day and age, we find that extramedullary disease can be challenging to manage. [It is] enriched with biologic high-risk features such as translocation 1416, deletion 17p, or TP53 mutations and appears to be more proliferative in nature. [It] doesn't matter if it's transplant eligible or ineligible patients, it appears to give poorer survival outcomes.

Whatever we know about the best possible regimens in the frontline, I think I made the case that utilizing quadruplet induction with or without transplant followed by 2 drug maintenance strategy, either with proteasome inhibitors [and] immunomodulatory drugs or with daratumumab and [the] IMiD such as lenalidomide may make more sense.

For patients who have early relapse with extramedullary disease, I made the case that there is compelling data from both the KarMMa-3 [and] the CARTITUDE-4 studies to utilize chimeric antigen receptor (CAR) T-cell therapies for these patients as these are regulatory approved and available to us.

Lastly, I talked about the promising bispecific combination data with teclistamab and talquetamab as a potential future direction, which we may be able to have that option for patients with extramedullary multiple myeloma. There are [also] certain small molecules as well as new dual-targeting strategies with trispecific antibodies or dual CAR-Ts that may also be appealing for this subset of patients.

Source:

Usmani S. Extramedullary Myeloma: Is There Any Hope? New Treatment Approaches. Presented at Lymphoma, Leukemia & Myeloma Congress; October 16-19, 2024. New York, NY.