Description:
The treatment of newly diagnosed myeloma has evolved rapidly with the new therapies and different combinations of these, resulting in deeper and more durable responses. The use of autologous stem cell transplantation has also evolved with this progress, and increasingly the initial treatment is being determined agnostic of the transplant eligibility and or desirability. In the decision making process, two factors play an important role, namely the underlying disease risk and the patient functional status or frailty. In particular, increasing disase risk calls for more intense treatments with the goal of achieving MRD negativity while frailty often limits the intensity of the combinations. Phase 3 trials continue to explore the role of quadruplet regimes in older patient populations with increasing depth of response and durable responses, and the nature of the combinations will evolve in the coming years with new classes of drugs being introduced, especially immunotherapies.

Autologous stem cell transplant has been an integral part of myeloma therapy for the past three decades. Originally envisaged as consolidation following initial treatment of newly diagnosed MM in those eligible to undergo the procedure, its role has evolved over time with investigations exploring various aspects including the types of conditioning regimens, role of post-transplant maintenance as well as tandem autologous stem cell transplantation. While the original phase 3 trials compared ASCT with no ASCT and demonstrated improved overall survival, subsequent trials studied the paradigm of delayed ASCT at the time of first relapse, demonstrating significant improvement in PFS but no OS advantage. As the initial therapies for treatment of myeloma has improved with high rate of deep responses, the role of ACT have continued ot be debated, but have maintained its position in the treatment with most recent trials continuing to show an improvement in PFS compared with no ASCT. Dr. Perrot's talk will focus on how ASCT is positioned in the treatment paradigm of MM.  

The overall survival in patients with MM over recent decades. This trend is anticipated to further advance with the emergence of T-cell redirecting therapies, including chimeric antigen receptor T-cell (CAR-T) therapy and T-cell engaging bispecific antibodies. Despite these therapeutic advancements, treatment-related adverse events likely impede quality of life. This underscores the imperative of optimizing supportive care strategies to maximize treatment outcomes. Such optimization is crucial not only for patient well-being but also for treatment adherence to sustain long-term disease control. Dr. Zweegmen will discuss treatment and prevention of bone disease, state of the art thrombosis prophylaxis and supportive care during T-cell redirecting therapies targeting BCMA and GPRC5d, amongst which prevention of infections.