Risk Stratification, Treatment Selection, and Transplant Eligibility in Multiple Myeloma: A Qualitative Study of the Perspectives and Self-Reported Practices of Oncologists

LeBlanc, Thomas W.; Howson, A. G.; Turell, Wendy; Locke, Susan C.; Tuchman, Sascha A.; Gasparetto, Cristina; Kaura, S.; Khan, Zeba M.; Abernethy, A. P.

doi:10.3747/co.23.3298

Cited by 3 publications

(5 citation statements)

References 26 publications

(35 reference statements)

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“…The patients' other demographic and laboratory details are described in Table 1 (additional details are given in Supporting Information S1: Table S5 ). Of 141, 45 patients were transplant‐ineligible as per standard criteria, 40 , 41 and the remaining 96 patients were planned for therapy without ASCT due to patient preference or resource constraints, or logistic issues. Ninety‐eight of 141 patients received VCd (bortezomib, cyclophosphamide, dexamethasone)‐based therapy and 43 of 141 received VRd (bortezomib, lenalidomide, dexamethasone)‐based therapy depending on patients' clinical status and financial conditions.…”

Section: Resultsmentioning

confidence: 99%

“…41,43 Even fewer patients undergo ASCT due to transplant ineligibility or resource/financial constraints in lower-and-middleincome countries (LMIC). 41,44,45 Our study was focused on patients not upfront planned for ASCT as less than 20% of our patients undergo ASCT. 45,46 In this study, circulating tumor plasma cells were detected in approximately 77% of patients, which is in the range reported by previous studies, that is, 67%-92% of NDMM patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although transplant remains an important treatment modality, with the advent of novel agents and the availability of treatment options at relapse, the role of upfront ASCT is being debated 42 . NDMM patients are increasingly treated without upfront ASCT as a deferred‐ASCT approach due to the availability of newer therapies achieving deeper responses 41,43 . Even fewer patients undergo ASCT due to transplant ineligibility or resource/financial constraints in lower‐and‐middle‐income countries (LMIC) 41,44,45 .…”

Section: Discussionmentioning

confidence: 99%

“… 42 NDMM patients are increasingly treated without upfront ASCT as a deferred‐ASCT approach due to the availability of newer therapies achieving deeper responses. 41 , 43 Even fewer patients undergo ASCT due to transplant ineligibility or resource/financial constraints in lower‐and‐middle‐income countries (LMIC). 41 , 44 , 45 Our study was focused on patients not upfront planned for ASCT as less than 20% of our patients undergo ASCT.…”

Section: Discussionmentioning

confidence: 99%

“… 41 , 43 Even fewer patients undergo ASCT due to transplant ineligibility or resource/financial constraints in lower‐and‐middle‐income countries (LMIC). 41 , 44 , 45 Our study was focused on patients not upfront planned for ASCT as less than 20% of our patients undergo ASCT. 45 , 46 …”

Section: Discussionmentioning

confidence: 99%

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Circulating tumor plasma cells and peripheral blood measurable residual disease assessment in multiple myeloma patients not planned for upfront transplant

Tembhare,

Sriram,

Khanka

et al. 2024

HemaSphere

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Circulating tumor plasma cells (CTPCs) provide a noninvasive alternative for measuring tumor burden in newly diagnosed multiple myeloma (NDMM). Moreover, measurable residual disease (MRD) assessment in peripheral blood (PBMRD) can provide an ideal alternative to bone marrow MRD, which is limited by its painful nature and technical challenges. However, the clinical significance of PBMRD in NDMM still remains uncertain. Additionally, data on CTPC in NDMM patients not treated with transplant are scarce. We prospectively studied CTPC and PBMRD in 141 NDMM patients using highly sensitive multicolor flow cytometry (HS‐MFC). PBMRD was monitored at the end of three cycles (PBMRD1) and six cycles (PBMRD2) of chemotherapy in patients with detectable baseline CTPC. Patients received bortezomib‐based triplet therapy and were not planned for an upfront transplant. Among baseline risk factors, CTPC ≥ 0.01% was independently associated with poor progression‐free survival (PFS) (hazard ratio [HR] = 2.77; p = 0.0047) and overall survival (OS) (HR = 2.9; p = 0.023) on multivariate analysis. In patients with detectable baseline CTPC, undetectable PBMRD at both subsequent time points was associated with longer PFS (HR = 0.46; p = 0.0037), whereas detectable PBMRD at any time point was associated with short OS (HR = 3.25; p = 0.004). Undetectable combined PBMRD (PBMRD1 and PBMRD2) outperformed the serum‐immunofixation‐based response. On multivariate analysis, detectable PBMRD at any time point was independently associated with poor PFS (HR = 2.0; p = 0.025) and OS (HR = 3.97; p = 0.013). Thus, our findings showed that CTPC and PBMRD assessment using HS‐MFC provides a robust, noninvasive biomarker for NDMM patients not planned for an upfront transplant. Sequential PBMRD monitoring has great potential to improve the impact of the existing risk stratification and response assessment models.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Circulating tumor plasma cells and peripheral blood measurable residual disease assessment in multiple myeloma patients not planned for upfront transplant

Tembhare,

Sriram,

Khanka

et al. 2024

HemaSphere

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show abstract

Review of the patient-centered communication landscape in multiple myeloma and other hematologic malignancies

LeBlanc

Eggly

Bylund

et al. 2019

Patient Education and Counseling

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Survey of patients and physicians on shared decision-making in treatment selection in relapsed/refractory multiple myeloma

Bylund

Eggly

LeBlanc

et al. 2023

Translational Behavioral Medicine

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Shared decision-making (SDM) is a key component of patient-centered healthcare. SDM is particularly pertinent in the relapsed and/or refractory multiple myeloma (RRMM) setting, in which numerous treatment options can present challenges for identifying optimal care. However, few studies have assessed the extent and relevance of SDM and patient-centered communication (PCC) in RRMM. To describe treatment decision-making patterns between physicians and patients in the RRMM setting, we conducted online surveys of patients and physicians in the USA to compare their perspectives on the process of treatment decision-making. We analyzed the surveys descriptively. Two hundred hematologists/oncologists and 200 patients with RRMM receiving second-line (n = 89), third-line (n = 65), and fourth-line (n = 46) therapy participated. Top treatment goals for physicians and patients included extending overall survival (among 76% and 83% of physicians and patients, respectively) and progression-free survival (among 54% and 77% of physicians and patients, respectively), regardless of the number of prior relapses. Thirty percent of physicians believed patients preferred a shared approach to treatment decision-making, while 40% of patients reported most often preferring a shared role in treatment decision-making. One-fourth of patients most often preferred physicians to make the final treatment decision after seriously considering their opinion. Thirty-two percent of physicians and 16% of patients recalled ≥3 treatment options presented at first relapse. Efficacy was a primary treatment goal for patients and physicians. Discrepancies in their perceptions during RRMM treatment decision-making exist, indicating that communication tools are needed to facilitate SDM and PCC.

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Risk Stratification, Treatment Selection, and Transplant Eligibility in Multiple Myeloma: A Qualitative Study of the Perspectives and Self-Reported Practices of Oncologists

Abstract: Background Since the early 2000s, treatment options for multiple myeloma have rapidly expanded, adding

Cited by 3 publications

References 26 publications

Circulating tumor plasma cells and peripheral blood measurable residual disease assessment in multiple myeloma patients not planned for upfront transplant

Circulating tumor plasma cells and peripheral blood measurable residual disease assessment in multiple myeloma patients not planned for upfront transplant

Review of the patient-centered communication landscape in multiple myeloma and other hematologic malignancies

Survey of patients and physicians on shared decision-making in treatment selection in relapsed/refractory multiple myeloma

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