Facing a difficult treatment decision in myeloma? Check out the new ASCO-CCO Myeloma Treatment Guidelines. ascopubs.org/doi/10.1200/... @jmikhaelmd.bsky.social @rahulbanerjeemd.bsky.social @ascocancer.bsky.social
From #ASH25: We break down the 10 most impactful myeloma breakthroughs, including advances in CAR T-cell therapy and bispecific antibodies and what this latest research means for people living with myeloma. Watch now: mmsm.link/4qeZrlU
#IMFASH25 #ASKTHEIMF
@jmikhaelmd.bsky.social
Pain is a reality for many people living with myeloma, but it can be managed. In this Myeloma in a Minute or Less video, Dr. Joseph Mikhael, Chief Medical Officer of the IMF, breaks down practical, patient-focused strategies to help manage myeloma-related pain.
www.myeloma.org/node/12242
This week! Join our free IMWG Conference Series webinar on December 17 when leading myeloma experts discuss the latest on myeloma research from the December 2025 American Society of Hematology Conference. RSVP >https://mmsm.link/4op7Q58
#mmsm #imfimwg #ASH25
You won't want to miss this! Join us at our free IMWG Conference Series webinar on December 17 to hear from a panel of #myeloma specialists on frontline therapy, MGUS, CAR T-cell therapy, and many more topics! Register now before spots run out: https://mmsm.link/4op7Q58
#mmsm #imfimwg
21/
1L in TE & TIE for NDMM
🔑 SUMMARY🔑
🎯Triplet WAS standard approach, but quad is🆕SOC
🎉Quad is preferred 1L for TE NDMM v triplet
🆕SOC: IsaRVd for TIE NDMM🎉
🎯MRD- emerging as a benchmark in🔬 & clin decision making
👏Great news for pts
& Don't forget to claim #CME > bonumce.short.gy/NDMM-TW1-Post
20/MIDAS eval’d MRD-guided consolidatn post 1L IsaKRd in TE NDMM
Post 1L, no 🔼 in MRD- rates for all pts
Tailoring tx to MRD post 1L may not ➡️ MRD-
If respond to 1L tx may not need tandem SCT to reach MRD-; cont anti-CD38 &PI
🤔High # pts w t(11;14): impact time to MRD- results?
19/ Looking across trials... e.g.
🔬CEPHEUS
🔬IMROZ
🔬GMMG-CONCEPT
🔬ADVANCE…
🥅 MRD negativity emerges as benchmark to create a level playing field
Across🔬, regimens, & now✅ FDA approved as clinical trial endpoint April ‘25
18/ADVANCE🔑trial demonstrating dara+ standard KRd ➡️↑outcomes in NDMM independent of TE
↑MRD- rate: 59% v 36%, adjOR = 2.5; P<0.0007➡️ 2.5x ↑MRD- rate w/DKRd
👉No new safety concerns
❓Impact on EFS, PFS & OS TBD
DKRd👉1L for all pts on KRd backbone regardless of TE status
17/📣GMMG-CONCEPT ASCO2025 update, TE pts:
73.2% MRD- post-consolidatn; p=1.91x10-13
86.8% MRD- @ any time
58.4% MRD- ≥CR
40.6% retained ≥2yr sust MRD-
Med follow-up: 43m(0-90.2m)
mPFS: 72.8m
5yr OS: 72%
6yr OS: 69%
⬆️2yr sustMRD-, ⬆️PFS, 69% OS @ 6yr
IsaKRd:🆕SOC for HRNDMM
16/👏if you chose to treat to MRD- & cont maint
GMMG-CONCEPT, largest cohort to eval MRD- in TE & TIE HRNDMM
IsaKRd inductn & consolidatn➡️IsaKR maint➡️
↑MRD- rate: 67.7% in TE & 54.2% in TIE
Sustained ≥1yr: 62.6% in TE & 46.2% in TIE
🎉IsaKRd➡️↑deep remissions
15/ Based on results of GMMG-CONCEPT presented @ #ASCO2025, which treatment strategy should be used for pts w/ HR NDMM?
💬 reply/comment w/ your answer 💬
1️⃣ Initiate allogeneic SCT
2️⃣ Choose IV instead of subQ
3️⃣ Treat to MRD- then d/c tx
4️⃣ Treat to MRD- & cont maintenance
14/Unfortunately, pts w high-risk (HR) #NDMM have 👎poorer prognosis & shorter survival rates vs standard-risk
13/🆕SOC for pts w SCT-deferred or TIE #NDMM🎉
NCCN (preferred, cat 1) & EHA-EMN (1st optn) regimens:
🎯DRd ‘til progression; de-escalate prn
🎯DVRd ‘til progression; de-escalate prn(<80 yr old, not frail)
🎯IsaVRd ‘til progression; de-escalate prn(<80 yr old, not frail)
#MMSM
12/BENEFIT eval'd wkly bortezomib (V) in TIE NDMM
IsaVRd➡️IsaVR➡️IsaR v IsaRd➡️IsaR➡️IsaR
↑MRD- rate @
12mo 51% v 21%; OR: 3.88; 95%CI: 2.27-6.62;P<0.0001
18mo 53% v 26%; OR: 3.16; 95%CI: 1.89-5.28;P<0.0001
🔑Wkly V in IsaRd=deep responses
Supports IsaVRd as🆕SOC for TIE NDMM
11/Do results w isa show similar trends?
IMROZ🔑trial
IsaVRd ➡️ IsaRd v VRd ➡️ Rd in TIE pts w NDMM
👉IsaVRd ➡️↓time to MRD-: 14.7 v 32.8m
👉↑ PFS @ 60m: 63.2 v 45.2%; HR: 0.60; P<0.001
👉↑ CR: 74.7% v 64.1%; P=0.01
IMROZ results support IsaVRd as 🎉 🆕 SOC for TIE #NDMM pts
10/ CEPHEUS🔑 trial in TIE & SCT-deferrd pts
DVRd ➡️ deeper, more durable MRD- rate
TIE cohort:
👉Overall MRD- 63.2 v 41.4%
👉Sustained MRD @ ≥12m 48.7 v 26.3%; P<0.0001
👉CR 81.2 v 61.6%; P<0.0001
👉HR 0.57, 95% CI 0.41-0.79; P=0.0005
↓D/C rate w quad
🎉DVRd new SOC for TIE NDMM🎉
9/CEPHEUS compared induction/consolidation w VRd ± daratumumab (D) followed by maintenance in transplant-ineligible (TIE) #NDMM
The DVRd arm demonstrated which of the following outcomes?
💬 REPLY👇
1️⃣ Deep, more durable MRD-
2️⃣ ⬆️MRD- rates. No🔺in PFS
3️⃣ Similar efficacy, ⬆️VTE
4️⃣ ⬆️ D/C rate in DVRd arm
8/🔬Exciting news for #mmsm
Quad tx as🆕SOC for #NDMM
Current EHA-EMN (1st optn) & NCCN (pref,cat 1) regimens for TE pts w/NDMM:
🎯DaraVRd➡️SCT➡️len maint
🎯IsaVRd SCT➡️len maint
👏to quad as 1L for TE pts👏
…but what about pts who are TIE /SCT-deferred?
7/⚡️GMMG-HD7 #ASCO25 update w/ PFS benefit in all quad recipients
↑CR 43.5% w IsaVRd v 34% w VRd
↑MRD- rate 66.2% w quad v 47.7% w triplet
👉PFS at 3yr benefit: 83% v 75% w/IsaVRd v VRd
↑MRD- regardless of maint v MRD+ (HR 0.61; P=0.002)
🔮Maintenance w Isa-len v len is on-going
6/🙋🏻What about replacing dara- with isa- in a quad?
GMMG-HD7: IsaVRd v VRd induction ➡️ isa-len v len maintenance in TE NDMM
👉↑ MRD- rate 50% v 36%; p =0.00017
👉IsaVRd had ↓AE rates & ↓d/c rates v RVd
🎉🆕 SOC
👉Results ➡️ addition of IsaVRd as induction regimen for TE NDMM
5/ PERSEUS #ASCO25: sustained MRD- in pts on quad maintenance median follow-up of 47.5m
👉 ↑ sustMRD- at ≥24m w DVRd v VRd: 55.8 v 22.6%
👉 Pts w ≥12m sustMRD-: ↑ 48m PFS, regardless of tx
👉 Only 3.1% progression at 18m w DVRd v 6.8% VRd
🔑 DVRd ➡️ 2.5x ⬆️ ≥24m sustMRD- & ½ progression risk at ≤18m tx
4/💃Quads are taking center stage in NDMM
Let’s look @ the📈 on quad tx
PERSEUS ~🔑 trial: SQ dara➕VRd ➡️ ↑outcomes in TE pts
👉↑PFS @ 48m 84.3 v 67.7%; HR: 0.42; P<0.001
👉↑MRD- rate 75.2 v 47.5%; P<0.001
👉↑CR rate 87.9 v 70.1%; P<0.001
🎉 🆕 SOC ~ quad instead of triplet 🎉
3/🥼In your practice, which regimen are you using most often for 1L therapy in pts w/ transplant eligible (TE) #NDMM?
☎️ #MedSky #HemeSky 💬 reply and let us know what you do in your practice?
1️⃣ DVRd quad
2️⃣ IsaVRd quad
3️⃣ DKRd or IsaKRd quad
4️⃣ VRd
5️⃣ other triplet
2/ Before we jump in, a few disclosures & important links🔗
1️⃣📖#CME info bonumce.short.gy/NDMM-TW1-CME
2️⃣Take the pre-survey 👉bonumce.short.gy/NDMM-TW1-Pre
3️⃣Get the latest NDMM quad tx efficacy data w/ 🧵👇
4️⃣🏆Claim🆓CME bonumce.short.gy/NDMM-TW1-Post
Now, let's get started!
#MMSM #MultipleMyeloma
⚡️#MedSky join me & my friend Dr. Krina Patel
In a #CME 🧵exploring efficacy of quad tx in #NDMM
🔬PERSEUS, GMMG-HD7 & CONCEPT, CEPHEUS, IMROZ, ADVANCE, MIDAS +++
🆓 CME from @bonumce.bsky.social
🔗 to CME ℹ️ 👉🏼 bonumce.short.gy/NDMM-TW1-CME
Supported by an edu grant from Janssen
