Podcasts about myeloma

Dr. Lisa Hicks and Dr. Joseph Mikhael discuss the updated guideline from ASCO and Ontario Health (Cancer Care Ontario) on the treatment of multiple myeloma. They cover recommendations for therapeutic options across smoldering multiple myeloma, transplant eligible multiple myeloma, transplant ineligible multiple myeloma, and relapsed or refractory multiple myeloma. They highlight the importance of shared decision making and patient-centric care. They comment on the explosion of new treatment options in this space and the impetus for this guideline becoming a living guideline, which will be updated on an ongoing, regular basis. Read the full guideline, "Treatment of Multiple Myeloma: ASCO-Ontario Health (Cancer Care Ontario) Living Guideline" at www.asco.org/hematologic-malignancies-guidelines. TRANSCRIPT This guideline, clinical tools and resources are available at www.asco.org/hematologic-malignancies-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology,  https://ascopubs.org/doi/10.1200/JCO-25-02587   Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today I am interviewing Dr. Lisa Hicks from St. Michael's Hospital and University of Toronto, and Dr. Joseph Mikhael from the Translational Genomics Research Institute, an affiliate of City of Hope Cancer Center, co-chairs on "Treatment of Multiple Myeloma: American Society of Clinical Oncology-Ontario Health (Cancer Care Ontario) Living Guideline." Thank you for being here today, Dr. Hicks and Dr. Mikhael. Dr. Lisa Hicks: Thanks so much. Dr. Joseph Mikhael: It is a pleasure to be with you, Brittany. Thank you. Brittany Harvey: Before we discuss this guideline, I would like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Hicks and Dr. Mikhael who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then to dive into what we are here today to talk about, Dr. Mikhael, I would like to start by recognizing that this guideline updates the 2019 ASCO-CCO Guideline on the Treatment of Multiple Myeloma. So what prompted this update and what is the scope of this updated guideline? Dr. Joseph Mikhael: It is amazing when we think back in myeloma years, 2019 actually seems a very, very long time ago because really so much has changed in myeloma over these last six to seven years. Indeed, there have been over 150 randomized controlled trials that we didn't have at the prior guideline that we reviewed for this. Myeloma is a disease that has really changed so dramatically over these last several years. Multiple new agents have been introduced. We now have CAR-T cell therapy, bispecific antibodies, and multiple other agents that were not available at the time. Furthermore, with this growing complexity, it is becoming more important than ever to be able to provide practical advice and guidelines to the oncology community. For most oncologists, they have less than 5% of their time dedicated to multiple myeloma. It is important to bring a clarity to them that allows them to care for their patients. And the scope of these guidelines, furthermore, really cover the whole spectrum of myeloma. They go further than our prior guideline where now we have included smoldering multiple myeloma along with frontline therapy and relapsed multiple myeloma. So, we have really tried to provide the full spectrum to our colleagues in oncology to ensure that they have the tools they need to provide the best care possible for their patients. Dr. Lisa Hicks: That is a really terrific summary. And maybe one thing I will just add is it is really unique to have this much literature. I can't think of another guideline that I have ever been involved with that has seen a field move so quickly and develop so many advancements in a period of just over four or five years. Brittany Harvey: Certainly, there is a large volume of evidence that you all had to review for this guideline update. I think to your point probably one of the greater volumes of literature for a guideline update that you both mentioned. Based on that, I would like to review the key recommendations that are updated in this guideline. So Dr. Hicks, that new patient population that Dr. Mikhael mentioned earlier, what are the key recommendations for patients with smoldering multiple myeloma? Dr. Lisa Hicks: So this is the first time that an ASCO guideline is addressing this branch of multiple myeloma care. It is an area where I think some guidance is needed, and smoldering myeloma is not an active cancer. And so one thing that I really want to highlight is that the panel felt very strongly that to recommend any therapy in this space we needed a higher level of evidentiary certainty, of evidentiary confidence, to make recommendations for active therapy. The panel really made two very important recommendations. First of all, the panel did not recommend treatment for low or intermediate risk smoldering myeloma. That is important. And then the area where I think for the first time we have recommended consideration of treatment is patients with high risk smoldering myeloma. And for patients with high risk smoldering myeloma, the panel recommended that it was appropriate to consider either treatment with daratumumab or careful observation. Dr. Joseph Mikhael: And I think that move forward as you have mentioned, Dr. Hicks, is particularly important because it is an area to some degree still of equipoise and many trials are going on in the area. But we do now have a strong phase III trial that supports the use of daratumumab monotherapy for three years when compared to close observation. But of course, that is not for everyone. And one of the key themes of all of our recommendations are going to be now that more and more choices are available, that we have discussions with our patients to ensure that we match the right treatment with the preference of the patient. And I think that is particularly important here in smoldering myeloma. Dr. Lisa Hicks: Multiple myeloma care and the multiple myeloma evidence is really so nuanced, and one of the nuances that readers will appreciate if they read the guideline is that how smoldering myeloma is risk stratified has been different across different trials. And that really adds to the complexity of this recommendation and is one of the reasons that the panel felt that it was appropriate to recommend either observation or treatment. Brittany Harvey: It is great to have these new recommendations for this unique patient population. And as you both mentioned, that individualized patient care is really important across this entire guideline. So then following those recommendations, Dr. Mikhael, what is recommended for initial therapy, autologous stem cell transplantation, post transplant therapy, and measurement of response for patients with transplant eligible multiple myeloma? Dr. Joseph Mikhael: Well, that is an area that has really considerably also grown since the last guideline. Obviously one would have to consult the guidelines to get every last detail, but in essence, we want to assess whether or not patients are transplant eligible or ineligible. And that assessment is not based on age or renal function alone, but indeed on a careful assessment of that patient. When that assessment is made and deemed that a patient is transplant eligible, our recommendation is that a patient typically would receive a quadruplet. That is to say, a monoclonal antibody directed against CD38, a proteasome inhibitor, an immunomodulatory drug, and dexamethasone to be given for approximately four to six cycles followed by the stem cell transplant, followed by potentially another two cycles of consolidation, and then maintenance therapy. A couple of important caveats. One, we do have two different CD38 antibodies that can be used, either daratumumab or isatuximab. Although typically bortezomib is the preferred proteasome inhibitor, consideration can be given to carfilzomib by virtue of the potential toxicity from bortezomib. And then lastly in the maintenance setting, we are typically recommending at least lenalidomide alone, but consideration can be given to dual maintenance therapy as the data is emerging to either add to that daratumumab or carfilzomib. All the while using the IMWG criteria for response. The goal of course is to achieve the deepest response possible and to maintain that response until such time as patients would relapse. Finally, the length of maintenance therapy continues to be an area of equipoise and study in multiple myeloma. And so at minimum, patients would receive two to three years of maintenance therapy, and based on risk status and depth of response it can be considered that patients would potentially come off maintenance therapy, of course always with the caveat that toxicity would influence length of therapy as well. Brittany Harvey: Yes, as you mentioned, evaluating which patients are eligible is extremely important for considering what is recommended in the guideline for both transplant eligible and transplant ineligible patients. So then Dr. Hicks, following those recommendations for transplant eligible multiple myeloma, what are the recommended treatments, goals of therapy, and measurement of response for patients with transplant ineligible multiple myeloma? Dr. Lisa Hicks: You know, I really can't emphasize enough how important an individualized patient assessment is. When we are thinking about the range of patients that are included in this category of transplant ineligible patients, it is a huge range. You may have fairly fit patients in their late 70s all the way to patients in their 90s. And we really want to see that treatments are tailored both to the fitness of the patient, their individual circumstances, and their preferences. And it is a wonderful thing to have lots of options for patients in this circumstance. What the guidelines have recommended for most patients who are transplant ineligible but fit enough for a stronger therapy is quadruplet therapy. So actually therapy that is very similar to what is being recommended in the transplant eligible population but for a longer period of time. And then for those patients who for whatever reason, be it their fitness or their preference, are not appropriate for that quadruplet therapy, the recommendation is for triplet therapy with a combination of lenalidomide, bortezomib, dexamethasone, or very often, more often in most cases, an antibody based approach with an anti-CD38 plus lenalidomide plus dexamethasone. Dr. Joseph Mikhael: The only thing I would add to that, I think we have to also, as we do mention in our recommendations, be particularly cautious with the dosing of these medications. Because even though we think of them as a single agent or a particular class, there can be quite a variation within the dosing regimen that can affect a patient's side effects and their quality of life. And so being very careful with dose modifications, and particularly in the transplant ineligible patient, is an important part of the recommendation as well. Dr. Lisa Hicks: Yeah, this is a podcast so no one can see me nodding vigorously that dose modification is so important particularly with those older and frailer patients, and with particular attention to trying to reduce dexamethasone doses and favoring weekly administration of bortezomib when that drug is used. Brittany Harvey: Absolutely. Considering the risks and benefits and patient preferences is really key to selecting therapy for these patients. So then Dr. Mikhael, for the final overarching patient population addressed in this guideline, for patients with relapsed or refractory multiple myeloma, what treatment options are recommended? Dr. Joseph Mikhael: This of course is, if you will, the biggest part of the guideline because there has been so much done in the relapse setting. And I think we start the guideline by saying a decision has to be made as to when to institute therapy. That there may be some patients with slow biochemical relapse that may be monitored for a period of time. But when the decision is made to initiate treatment, instead of a simple algorithm, the guideline emphasizes the fact that there are multiple choices that can be given to a patient that are going to match what comorbidities the patient has, what they have been treated with before, and of course what their preferences are. I think we highlight two particular areas. That now that CAR-T cell therapy is available as early as first relapse, it should be a consideration by virtue of the fact that it has resulted in such deep and durable responses. But that triplets should also be considered in that earlier relapse setting because we do have multiple classes of agents that can be used. We know that in later relapse options exist including bispecific antibodies for which we have four different choices. And that in general, patients will ultimately receive either a triplet or CAR-T cell therapy in earlier relapse, but there are some patients who may be eligible only for a doublet by virtue of their comorbidities and of their prior therapies. Lastly, it really does emphasize the point as we have mentioned a few times in this podcast, and I am so glad it keeps coming up, is that as I often say we don't treat myeloma, we treat people. And engaging the patient in that conversation to ensure that the right treatment gets matched to the right patients is particularly important because with all the new classes that we have with antibody drug conjugates, with XPO1 inhibitors, the traditional three classes of proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, along with as we have already mentioned CAR-T and bispecific antibodies, it really is an incredible laundry list of choice. And making that choice specific to the patient becomes absolutely critical. I should also lastly note that there are patients who may defer their initial transplant. There may be patients who may be eligible for a second transplant. So autologous stem cell transplant, although primarily used in the frontline setting, may still be a consideration for a smaller subset of patients in the relapse setting. Dr. Lisa Hicks: I think maybe one thing that I would add is an overarching principle which is actually similar to a principle in the first guideline, and that is that in the relapsed or refractory setting, there are many different treatment options. And in fact, the number of treatment options feels like it is evolving every day. But an overarching principle for clinicians to consider is to try and choose combinations of drugs that the patient has either not been exposed to in the past or certainly that they are not refractory to. We really want to be pulling new options out of the toolbox as much as we can. Dr. Joseph Mikhael: Very often we do see where someone may be on a triplet and they are progressing on it and someone just changes out one drug. We have suggested not to take that approach but to take the approach of completely introducing a new therapy when someone is progressing on their current therapy. I think that point is particularly important and the consensus panel was very clear. Brittany Harvey: Understood. That is very helpful when thinking about what options to offer to patients in the relapsed and refractory setting. And as you mentioned earlier, the figures in this guideline provide an outline of options and then the tables really go into some of the details and outcomes of the trials, and those are very helpful for clinicians to refer to. So then Dr. Hicks, we have talked a little bit about some of the nuances of the guideline, but what should clinicians know as they implement these new and updated recommendations? Dr. Lisa Hicks: I think they should feel comfortable that these are trustworthy guidelines. So these are evidence-based guidelines that have been rigorously developed after a very thorough evidence review and put together by a panel of experts who were extremely thoughtful in their review of the evidence. And so all of this contributes to the trustworthiness of the guidance. And then I would also encourage people to take a deep look at the guidelines because of the importance of nuance that is addressed in them, and then to also explore some of the tools that ASCO is developing that helps with implementation including the flow charts that are contained within the guidelines and some additional tools that are available online. Brittany Harvey: Absolutely. The tools and resources for this guideline are available online with the publication and we will provide links to that in the show notes of the episode. So then following that, Dr. Mikhael, how does this guideline update affect patients with multiple myeloma? Dr. Joseph Mikhael: As we sort of intimated earlier, I like to say I don't treat myeloma, I treat people. I think we should always be patient-centric and patient-focused. And I think in the discussion we always were. We always wanted to ensure that multiple factors go into a decision-making process. We are not just looking at the biology of the disease, we are looking at patient factors. Those patient factors include their frailty as we commented in a frailty assessment, their preferences, their comorbidities. And I think, in a day where we have so many choices, we emphasize in the guideline the importance of that conversation with the patient. That, if you will, shared decision-making model where options are laid out and based on the patient factors and the treatment factors they can then be meshed together in the best way so that patients can make the right choice. And of course in conjunction with the guidelines, we have patient friendly summaries of them. And we involved, of course, patients in the development of these guidelines. And I think that is one of the greatest strengths of the ASCO guidelines is that there is a patient with us at the table who is giving their perspective on the guideline as we go forward. So I am very thankful that we have created a product that is, if you will, not only for the providers, the practitioners that are prescribing these agents and that are directly giving the care, but indeed for the very patients who of course have the most at stake here. Dr. Lisa Hicks: Yeah Joe, I am so glad you called out the participation of patient partners in the guideline. It is such an important part and they were really- the patient partner was such an important part of this panel in helping us understand the patient perspective as we developed this guidance. Brittany Harvey: Definitely. It is a hugely important role for the panel and for all of the panel including the patient partners and the experts in the disease to review the evidence and come up with comprehensive recommendations. And yes, as you mentioned, the individualized treatment and the shared decision-making is really paramount to this guideline. Finally, Dr. Hicks, you alluded to earlier the vast number of treatment options that is really exploding in multiple myeloma. And so this guideline is becoming a living guideline continuously updated by ASCO. So what are the outstanding questions regarding this topic and what evidence is the panel looking forward to for future updates? Dr. Lisa Hicks: I am really excited about this. This is one of the first guidelines that will be a living guideline for ASCO and it is such a good fit. You have heard Joe and I say a few times how quickly this field is moving, how complex the field is. I think everyone on the panel knew that no matter how quickly we did it and how deeply we reviewed the evidence, it was inevitable that more evidence would be generated as we were putting out the guideline. In a field like that, it is really important that we find a way to provide evidence-based guidelines quickly to the community. You know, waiting another five years, letting another 150 trials accrue before we do another guideline is not what the community needs. And so ASCO has really risen to this challenge and is committed to living guidelines. And so a living guideline is a guideline that commits to reviewing the evolving evidence on an ongoing basis, watching for practice changing trials, and having a standing panel that will review evidence and update recommendations on a regularly scheduled basis. So that is what a living guideline is, and that is what this guideline is becoming. That is just the first thing in terms of what a living guideline is. And then what are we watching? Well, honestly what aren't we watching? There is so much happening in multiple myeloma. We knew as we put the guideline out that there were trials in process, some trials that had been released at conferences but not yet published. We will be waiting for those and if they are practice changing they will be addressed in upcoming updates. There is new evidence just recently presented around combined anti-CD38 and bispecific antibodies. I don't know yet whether that will be addressed but I wouldn't be surprised if it was. There are so many things coming down the pipeline and it is just wonderful that there is going to be a way to try and address them in a robust fashion. Dr. Joseph Mikhael: Yeah I agree with you, Lisa. I can't think of another disease that would be more relevant for a living guideline. I mean we had difficulty because new data kept coming in as we were making recommendations. And so at some point we had to draw a line and say this is where we will stop and produce this guideline and have it ongoing. And I really look forward to seeing the updates because we know as you mentioned that there are so many things that are on the verge of approval and on the verge of changing the way we manage this terrible disease. And before I close, I would love to remind all of our listeners that as we commented from the start, patient engagement is critical at ASCO and in our guidelines process. Unfortunately we lost a very dear patient during the guidelines process, and that is Jack Aiello. Jack Aiello had been a patient and a patient advocate for many, many years in the myeloma community. And indeed we have actually dedicated these guidelines to his honor. And so I thought it would be valuable for us to mention that today. And we miss you Jack, but we are very grateful that we have been able to dedicate this excellent body of work to your memory. Brittany Harvey: Absolutely. This guideline and your dedication to him is an honor to his memory and we really recognize him in thinking about this guideline. We will look forward to those future trial results that you mentioned, Dr. Hicks, to update this guideline and continue to provide options for patients with multiple myeloma and improve upon those options and shared decision-making with patients. So I want to thank you both for all of your work to develop this guideline and for your time today, Dr. Hicks and Dr. Mikhael. Dr. Lisa Hicks: You are so welcome. Thanks for featuring this guideline. Dr. Joseph Mikhael: Thank you so much, Brittany. It has been a privilege. Brittany Harvey: Finally, thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/hematologic-malignancies-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines App, which is available in the  Apple App Store or the Google Play Store. If you have enjoyed what you have heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

 Join hosts Raj, Ashwin, and Eddie in this episode of Blood Cancer Talks as they welcome Dr. Luciano Costa, the first author of the NEJM manuscript on the MajesTEC-3 RCT, which was presented at ASH 2025. This episode dives deep into the trial's topline findings, capturing the nuances of the patient population, efficacy and safety data, and the future implications for treatment. The episode also examines the comparative efficacy of bispecific T-cell engagers versus CAR-T therapies, along with spirited discussion on the potential for fixed-duration treatment in myeloma care. Episode Highlights Main Topics Covered MajesTEC-3 Trial: Teclistamab-Daratumumab vs. Standard of Care Trial design and patient populationPrimary endpoint: Progression-free survival (PFS)MRD negativity rates and depth of responseOverall survival and safety profileClinical implications for treatment selectionTreatment Selection in Early Relapse Comparing MajesTEC-3 and CARTITUDE-4 patient populationsFramework for choosing between bispecific antibodies vs. CAR T-cell therapyManaging anti-CD38 exposed patientsLink to the NEJM paper: https://www.nejm.org/doi/abs/10.1056/NEJMoa2514663  

We bring back our prior pharmacology discussion because it's so incredibly important for the conversations that are on the horizon over the next few weeks. In this continuation of our myeloma series, we begin our discussion about treatment options for multiple myeloma, focusing first on pharmacology. We are so thrilled to have a special guest, Kathryn Maples, PharmD, BCOP who is a clinical pharmacy specialist in Multiple Myeloma at the Winship Cancer Institute of Emory Healthcare in Atlanta, Georgia!Content:- What are common drugs we use in "triplet regimens"? "quadruple therapy"? - What considerations must we take into account when prescribing commonly used medications in myeloma? - How should we counsel our patients? - What about supportive care?- How and when do we make dose adjustments? - This episode is SO eye-opening about the "behind the scenes" of myeloma care that physicians do not seeWant to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

In this podcast episode, Jesus Berdeja, MD; Amrita Krishnan, MD, FACP; and Niels van de Donk, MD, PhD, address key questions on CELMoD agent therapy for multiple myeloma, including:Combination strategiesAdverse event managementWhere CELMoD agents may best fit within current and future treatment strategies Presenters: Jesus Berdeja, MDDirector of Multiple Myeloma ResearchGreco-Hainsworth Centers for ResearchTennessee OncologyNashville, TennesseeAmrita Krishnan, MD, FACPDirector, Judy and Bernard Center for Myeloma, City of HopeNason Hollingsworth Family Chair MyelomaExecutive Director, Hematology, City of Hope Orange CountyProfessor Hematology/HCTIrvine, California Niels van de Donk, MD, PhDProfessor of HematologyDepartment of HematologyAmsterdam UMC, Location VUmcAmsterdam, NetherlandsContent based on an online CME program supported by an educational grant from Bristol Myers Squibb.Link to full program:https://bit.ly/4qvRwQM Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This Editor's Special Episode of The HemOnc Pulse features Paul G. Richardson, MD, of Dana-Farber Cancer Institute, discussing treatment strategies for relapsed/refractory multiple myeloma and where selinexor-based regimens fit in today's evolving landscape. Drawing from real-world cases, Dr. Richardson explores care for patients before CAR T, after CAR T relapse, and in between—highlighting how selinexor can be used flexibly across multiple lines, including as a bridge to future immunotherapies. The conversation emphasizes individualized, dynamic treatment planning to balance disease control, tolerability, and long-term goals in an increasingly complex era of myeloma care.

We bring back our prior pharmacology discussion because it's so incredibly important for the conversations that are on the horizon over the next few weeks. In this continuation of our myeloma series, we begin our discussion about treatment options for multiple myeloma, focusing first on pharmacology. We are so thrilled to have a special guest, Kathryn Maples, PharmD, BCOP who is a clinical pharmacy specialist in Multiple Myeloma at the Winship Cancer Institute of Emory Healthcare in Atlanta, Georgia!Content:- What are common drugs we use in "triplet regimens"? "quadruple therapy"? - What considerations must we take into account when prescribing commonly used medications in myeloma? - How should we counsel our patients? - What about supportive care?- How and when do we make dose adjustments? - This episode is SO eye-opening about the "behind the scenes" of myeloma care that physicians do not seeWant to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

I spoke with Allen Rolleri about his family's experience dealing with multiple myeloma, a rare and incurable form of cancer. The Rock Out Myeloma fundraiser takes place January 15, raising funds to support families facing the financial realities that come with long-term treatment. On #NoVacancyNews, Allen explains what the diagnosis meant in practical terms, how quickly his family had to learn about the disease, and why costs outside of medical bills often become part of the challenge. The conversation stays focused on awareness gaps, everyday expenses people don't anticipate, and how support often comes in specific, practical forms. Topics covered:

In this episode of the Ori Spotlight Podcast, Jason C. Foster welcomes Jonathan Gluck, an award-winning journalist and author of An Exercise in Uncertainty, for a deeply personal conversation about illness, identity, and the evolving promise of cell therapy.Jonathan shares his 20-year journey with multiple myeloma, from the early days of treatment to receiving CAR-T therapy, and reflects on what it means to live – and write – through chronic uncertainty. Together, they explore the patient experience behind clinical progress, and the human stories that often get lost between endpoints and approvals.

In today's episode, we continue our myeloma series, this time we'll delve deeper into the spectrum of plasma cell dyscrasias, including defining MGUS, discussing surveillance of MGUS, defining smoldering myeloma (SM). We are slowly inching our discussion towards the diagnosis of Multiple myeloma (MM)!Content:- Defining MGUS- Discussing risk of progression of MGUS to MM- How to interpret free light chains in renal failure- How do we monitor MGUS patients?- When do we do additional testing in MGUS?- What is smoldering myeloma?- What are myeloma defining events?- How do we risk stratify SM patients?- How do we monitor SM patients? Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesThis episode has been sponsored by Primum. To sign up for a free account, check out: tfoc.primum.co ** Want to review the show notes for this episode and others? Check out our website: Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube

Dr. Monty Pal and Dr. Jason Westin discuss the federal funding climate for cancer research and the persistent problem of drug shortages, two of the major concerns facing the oncology community in 2026. TRANSCRIPT Dr. Monty Pal: Hello and welcome to the ASCO Daily News Podcast. I am your host, Dr. Monty Pal. I am a medical oncologist and vice chair of academic affairs at the City of Hope Comprehensive Cancer Center in Los Angeles. There are always multiple challenges facing oncologists, and today, we discuss two of them that really stand out for 2026: threats to federal funding for cancer research and the persistent problem of drug shortages. I am thrilled to welcome Dr. Jason Westin, who believes that one way to meet these challenges is to get oncologists more involved in advocacy, and he will share some strategies to help us meet this moment in oncology. Dr. Westin is a professor in the Department of Lymphoma and Myeloma at the University of Texas MD Anderson Cancer Center, but he actually wears a lot of hats within ASCO. He is a member of the Board of Directors and has also previously served as chair of ASCO's Government Relations Committee. And he is also one of the inaugural members of ASCO's Political Action Committee, or PAC. He has testified before Congress about drug shortages and many other issues. Dr. Westin, I am really excited to have you on the podcast today and dive into some of these elements that will really impact our community in 2026. Thanks so much for joining us today. Dr. Jason Westin: Thank you for having me. Dr. Monty Pal: You've had such a range of experience. I already alluded to you testifying before Congress. You've actually run for office before. You wear so many different hats. I'm used to checking my PubMed every other day and seeing a new paper out from you and your group, and you publish in the New England Journal [of Medicine] on practice-setting standards and the diseases that you treat. But you've also done all this work in the domain of advocacy. I can't imagine that balancing that is easy. What has sort of motivated you on the advocacy front? Dr. Jason Westin: Advocacy to me is another way to apply our skills and help more people than just those that you're sitting across from at the time. Clinical research, of course, is a tool to try and take what we know and apply it more broadly to people that you'll never meet. And advocacy, I think, can do the same thing, where you can have a conversation with a lawmaker, you can advocate for a position, and that hopefully will help thousands or maybe even more people down the road who you'd never get to directly interact with. And so, I think it's a force multiplier in the same way that research can be. And so, I think advocacy is a wonderful part of how doctors care for our patients. And it's something that is often difficult to know where to start, but once people get into advocacy, they can see that the power, the rewarding nature of it is attractive, and most people, once they get going, continue with that through the rest of their career. Dr. Monty Pal: So, I'll ask you to expand on that a little bit. We have a lot of our younger ASCO members listening to this podcast, folks that are just starting out their careers in clinical practice or academia. Where does that journey begin? How do you get to the point that you're testifying in front of Congress and taking on these bigger sort of stances for the oncology community? Dr. Jason Westin: Yeah, with anything in medicine and in our careers, you have to start somewhere. And often you start with baby steps before you get in front of a panel of senators or other high-profile engagement opportunities. But often the first setting for junior colleagues to be engaged is doing things – we call them "Hill Days" – but basically being involved in kind of low-stakes meetings where you're with a group of peers, some of whom have done this multiple times before, and can get engaged talking to members of representatives' offices, and doing so in a way where it's a natural conversation that you're telling a story about a patient in your clinic, or that you're telling a personal experience from a policy that impacted your ability to deliver optimal care. It sounds stressful, but once you're doing it, it's not stressful. It's actually kind of fun. And it's a way that you can get comfort and skill with a group of peers who are there and able to help you. And ASCO has a number of ways to do that, both at the federal level, there's the Hill Day where we each April have several hundred ASCO members travel to Capitol Hill. There's also state engagement that can be done, so-called visiting at home, when representatives from the U.S. Congress or from state legislators are back in district. You can meet with your own representatives on behalf of yourself, on behalf of your organization, and advocate for policies in a way that can be beneficial to your patients. But those initial meetings that are in the office often they're low stakes because you could be meeting not with the representative but with their staff. And that staff sometimes is as young or even younger than our junior colleagues. These sometimes can be people in their 20s, but they're often extremely knowledgeable, extremely approachable, and are used to dealing with people who are new to advocacy. But they actually help make decisions within the office. So it's not a waste of time. It's actually a super useful way to engage. So, it's that first step of anything in life. The activation energy is always high to do something new. But I'd encourage people who are listening to this podcast already having some level of interest about it to explore ways that they could engage more. Dr. Monty Pal: You know, I have to tell you, I'm going to riff on what you just said for a second. ASCO couldn't make it any easier, I think, for folks to participate and get involved. So, if you're listening to this and scratching your head and thinking, "Well, where do I begin? How do I actually sign on for that meeting with a local representative?" Go to the ASCO ACT Network website. And I'll actually talk to our producer, Geraldine, to make sure we've got a link to that somewhere associated with this podcast after it's published, Jason, but I actually keep that on my browser and it's super easy. I check in there every now and then and see if there's any new policy or legislation that ASCO, you know, is sort of taking a stance on, and it gives me some fodder for conversation with my local representatives too. I mean, it's just an awesome, awesome vehicle. I'm going to segue right from there right to the issues. So, you and I are both at academic centers. You know, I think this is something that really pervades academia and enters into implications for general clinical practice. There's been this, you know, massive sort of proposal for decreased funding to the NCI and to the NIH and so forth. Tell us what ASCO is doing in that regard, and tell us perhaps how our community can help. Dr. Jason Westin: We live in interesting times, and I think that may be an understatement x 100. But obviously investments in research are things that when you're at an academic center, you see and feel that as part of your daily life. Members of Congress need to be reminded of that because there's a lot of other competing interests out there besides investing in the future through research. And being an elected representative is a hard job. That is something where you have to make difficult choices to support this, and that may mean not supporting that. And there's lots of good things where our tax dollars could be spent. And so, I'm sympathetic to the idea that there's not unlimited resources. However, ASCO has done an excellent job, and ASCO members have led the charge on this, of stating what research does, what is the benefit of research, and therefore why should this matter to elected representatives, to their staff, and to those people that they're elected to serve. And ASCO has led with a targeted campaign to basically have that message be conveyed at every opportunity to elected representatives. And each year on Hill Day, one of the asks that we have is to continue to support research: the NCI, NIH, ARPA-H, these are things that are always in the asks to make sure that there's appropriate funding. But effectively playing offense by saying, "It's not just a number on a sheet of paper, this is what it means to patients. This is what it means to potentially your loved ones in the future if you are in the opposite situation where you're not on the legislative side, but you're in the office receiving a diagnosis or receiving a difficult piece of news." We only have the tools we have now because of research, and each breakthrough has been years in the making and countless hours spent funded through the engine of innovation: clinical research and translational research. And so ASCO continues to beat that drum. You mentioned earlier the ACT Network. Just to bring that back again is a very useful, very easy tool to communicate to your elected representatives. When you sign up on the ASCO ACT website, you get emails periodically, not too much, but periodically get emails of, "This is a way you can engage with your lawmakers to speak up for this." And as you said, Monty, they make it as easy as possible. You click the button, you type in your address so that it figures out who your elected representatives are, and then it will send a letter on your behalf after like five clicks to say, "I want you to support research. I want you to vote for this particular thing which is of interest to ASCO and by definition to members of ASCO." And so the ACT Network is a way that people listening can engage without having to spend hours and significant time, but just a few clicks can send that letter to a representative in Congress. And the question could be: does that matter? Does contacting your senator or your elected representative do anything? If all they're hearing is somebody else making a different argument and they're hearing over and over again from people that want investments in AI or investments in something else besides cancer research, whatever it is, they may think that there's a ground shift that people want dollars to be spent over here as opposed to at the NIH or NCI or in federally funded research. It is important to continue to express the need for federal funding for our research. And so, it really is important for folks to engage. Dr. Monty Pal: 100%. One of the things that I think is not often obvious to a lot of our listeners is where the support for clinical trials comes from. You know, you've obviously run the whole gamut of studies as have I. You know, we have our pharmaceutical company-sponsored studies, which are in a particular bucket. But I would say that there's a very important and critical subset of studies that are actually government funded, right? NCI-funded clinical trials. If you don't mind, just explain to our audience the critical nature of the work that's being done in those types of studies and if you can, maybe compare and contrast the studies that are done in that bucket versus perhaps the pharmaceutical bucket. Dr. Jason Westin: Both are critical, and we're privileged that we have pharma studies that are sponsored and federally funded clinical research. And I think that part of a healthy ecosystem for us to develop new breakthroughs has a need for both. The pharma sponsored studies are done through the lens of trying to get an approval for an agent that's of interest so that the pharma company can then turn around and use that outside of a clinical trial after an FDA approval. And so those studies are often done through the lens of getting over the finish line by showing some superiority over an existing treatment or in a new patient population. But they're done through that lens of kind of the broadest population and sometimes relatively narrow endpoints, but to get the approval so that then the drug can be widely utilized. Clinical trials done through cooperative groups are sometimes done to try and optimize that or to try and look at comparative things that may not be as attractive to pharma studies, not necessarily going for that initial approval, but the fine tuning or the looking at health outcomes or looking at ensuring that we do studies in representative populations that may not be as well identified on the pharma sponsored trials, but basically filling out the gaps in the knowledge that we didn't gain from the initial phase 3 trial that led to the approval. And so both are critical. But if we only do pharma sponsored trials, if we don't fund federally supported research and that dries up, the fear I have, and many others have, is that we're going to be lacking a lot of knowledge about the best ways to use these great new therapies, these new immune therapies, or in my team, we do a lot of clinical trials on CAR T-cell therapies. If we don't have federally funded research to do the important clinical studies, we'll be in the dark about the best ways to use these drugs, and that's going to be a terrible shame. And so we really do need to continue to support federal research. Dr. Monty Pal: Yeah, there are no softball questions on this podcast, but I think everybody would be hard pressed to think that you and I would come on here and say, "Well, no, we don't need as much money for clinical trials and NCI funding" and so forth. But I think a really challenging issue to tackle, and this is something we thought to ask you ahead of the podcast, is what to do about the general climate of, you know, whether it's academic research or clinical practice here that seems to be getting some of our colleagues thinking about moving elsewhere. I've actually talked to a couple of folks who are picking up and moving to Europe for a variety of considerations, other continents, frankly. The U.S. has always been a leader when it comes to oncology research and, one might argue, research in general. Some have the mindset these days that we're losing that footing a little bit. What's your perspective? Are you concerned about some of the trends that you're seeing? What does your crystal ball tell you? Dr. Jason Westin: I am highly concerned about this. I think as you said, the U.S. has been a leader for a long time, but it wasn't always. This is not something that's preordained that the world-leading clinical research and translational research will always be done in the United States. That is something that has been developed as an ecosystem, as an engine for innovation and for job development, new technology development, since World War II. That's something that through intentional investments in research was developed that the best and brightest around the world, if they could choose to go anywhere, you wanted them to come to work at universities and academic places within the United States. And I think, as you said, that's at risk if you begin to dry up the investment in research or if you begin to have less focus on being engaged in research in a way that is forward thinking, not just kind of maintaining what we do now or only looking at having private, for profit sponsored research. But if you don't have the investment in the basic science research and the translational research and the forward-thinking part of it, the fear is that we lose the advantage and that other countries will say, "Thank you very much," and be happy to invest in ways to their advantage. And I think as you mentioned, there are people that are beginning to look elsewhere. I don't think that it's likely that a significant population of researchers in the U.S. who are established and have careers and families – I don't think that we're going to see a mass exodus of folks. I think the real risk to me is that the younger, up-and-coming people in undergraduate or in graduate school or in medical school and are the future superstars, that they could either choose to go into a different field, so they decide not to go into what could be the latest breakthroughs for cancer patients but could be doing something in AI or something in a different field that could be attractive to them because of less uncertainty about funding streams, or they could take that job offer if it's in a different country. And I think that's the concern is it may not be a 2026 problem, but it could be a 2036 or a 2046 problem that we reap what we sow if we don't invest in the future. Dr. Monty Pal: Indeed, indeed. You know, I've had the pleasure of reviewing abstracts for some of our big international meetings, as I'm sure you've done in the past too. I see this trend where, as before, we would see the preponderance of large phase 3 clinical trials and practice setting studies being done here in the U.S., I'm seeing this emergence of China, of other countries outside of the U.S. really taking lead on these things. And it certainly concerns me. If I had to sort of gauge this particular issue, it's at the top of my list in terms of what I'm concerned about. But I also wanted to ask you, Jason, in terms of the issues that are looming over oncology from an advocacy perspective, what else really sort of keeps you up at night? Dr. Jason Westin: I'm quite concerned about the drug shortages. I think that's something that is a surprisingly evergreen problem. This is something that is on its face illogical that we're talking about the greatest engine for research in the world being the United States and the investment that we've made in drug development and the breakthroughs that have happened for patients all around the world, many of them happen in the United States, and yet we don't necessarily have access to drugs from the 1970s or 1980s that are cheap, generic, sterile, injectable drugs. This is the cisplatins and the vincristines and the fludarabine type medications which are not the sexy ones that you see the ads in the magazine or on TV at night. These are the backbone drugs for many of our curative intent regimens for pediatrics and for heme malignancies and many solid tumors. And the fact that that's continuing to be an issue is, in my opinion, a failure to address the root causes, and those are going to require legislative solutions. The root causes here are basically a race to the bottom where the economics to invest in quality manufacturing really haven't been prioritized. And so it's a race to the cheapest price, which often means you undercut your competitor, and when you don't have the money to invest in good manufacturing processes, the factory breaks down, there's no alternative, you go into shortage. And this has been going on for a couple of decades, and I don't think there's an end in sight until we get a serious solution proposed by our elected officials. That is something that bothers me in the ways where we know what we should be doing for our patients, but if we don't have the drugs, we're left to be creative in ways we shouldn't have to do to figure out a plan B when we've got curative intent therapies. And I think that's a real shame.  There's obviously a lot of other things that are concerning related to oncology, but something that I have personally had experience with when I wanted to give a patient a CAR T-cell, and we don't have a supply of fludarabine, which is a trivial drug from decades ago in terms of the technology investments in genetically modified T-cells, to not then have access to a drug that should be pennies on the dollar and available at any time you want it is almost like the Air Force investing in building the latest stealth bomber, but then forgetting to get the jet fuel in a way that they can't use it because they don't have the tools that they need. And so I think that's something that we do need to have comprehensive solutions from our elected officials. Dr. Monty Pal: Brilliantly stated. I like that analogy a lot. Let's get into the weeds for a second. What would that proposal to Congress look like? What are we trying to put in front of them to help alleviate the drug shortages? Dr. Jason Westin: We could spend a couple hours, and I know podcasts usually are not set up to do that. And so I won't go through every part. I will direct you that there have been a couple of recent publications from ASCO specifically detailing solutions, and there was a recent white paper from the Senate Finance Committee that went through some legislative solutions being explored. So Dr. Gralow, ASCO CMO, and I recently had a publication in JCO OP detailing some solutions, more in that white paper from the Senate Finance. And then there's a working group actually going through ASCO's Health Policy Committee putting together a more detailed proposal that will be published probably around the end of 2026. Very briefly, what needs to happen is for government contracts for purchasing these drugs, there needs to be an outlay for quality, meaning that if you have a manufacturing facility that is able to deliver product on time, reliably, you get a bonus in terms of your contract. And that changes the model to prioritize the quality component of manufacturing. Without that, there's no reason to invest in maintaining your machine or upgrading the technology you have in your manufacturing plant. And so you have bottlenecks emerge because these drugs are cheap, and there's not a profit margin. So you get one factory that makes this key drug, and if that factory hasn't had an upgrade in their machines in 20 years, and that machine conks out and it takes 6 months to repair or replacement, that is an opportunity for that drug to go into shortage and causes a mad dash for big hospitals to purchase the drug that's available, leaving disparities to get amplified. It's a nightmare when those things happen, and they happen all the time. There are usually dozens, if not hundreds, of drugs in shortage at any given time. And this has been going on for decades. This is something that we do need large, system-wide fixes and that investment in quality, I think, will be a key part. Dr. Monty Pal: Yeah, brilliantly said. And I'll make sure that we actually include those articles on the tagline for this podcast as well. I'll talk to our producer about that as well.  I'm really glad you mentioned the time in your last comment there because I felt like we just started, but in fact, I think we're right at our close here, Jason, unfortunately. So, I could have gone on for a couple more hours with you. I really want to thank you for these absolutely terrific insights and thank you for all your advocacy on behalf of ASCO and oncologists at large. Dr. Jason Westin: Thank you so much for having me. I have enjoyed it. Dr. Monty Pal: Thanks a lot. And many thanks to our listeners too. You can find more information about ASCO's advocacy agenda and activities at asco.org. Finally, if you value the insights that you heard today on the ASCO Daily News Podcast, please rate, review, and subscribe wherever you get your podcasts. Thanks so much. ASCO Advocacy Resources: Get involved in ASCO's Advocacy efforts: ASCO Advocacy Toolkit Crisis of Cancer Drug Shortages: Understanding the Causes and Proposing Sustainable Solutions, JCO Oncology Practice Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Find out more about today's speakers:     Dr. Monty Pal   @montypal   Dr. Jason Westin @DrJasonWestin   Follow ASCO on social media:      @ASCO on X     ASCO on Bluesky    ASCO on Facebook      ASCO on LinkedIn      Disclosures:     Dr. Monty Pal:    Speakers' Bureau: MJH Life Sciences, IntrisiQ, Peerview   Research Funding (Inst.): Exelixis, Merck, Osel, Genentech, Crispr Therapeutics, Adicet Bio, ArsenalBio, Xencor, Miyarsian Pharmaceutical   Travel, Accommodations, Expenses: Crispr Therapeutics, Ipsen, Exelixis   Dr. Jason Westin: Consulting or Advisory Role: Novartis, Kite/Gilead, Janssen Scientific Affairs, ADC Therapeutics, Bristol-Myers Squibb/Celgene/Juno, AstraZeneca, Genentech/Roche, Abbvie, MorphoSys/Incyte, Seattle Genetics, Abbvie, Chugai Pharma, Regeneron, Nurix, Genmab, Allogene Therapeutics, Lyell Immunopharma Research Funding: Janssen, Novartis, Bristol-Myers Squibb, AstraZeneca, MorphoSys/Incyte, Genentech/Roche, Allogene Therapeutics

It's been 3 years since our last myeloma series updates and the reality is, a lot has changed! Instead of releasing an updates episode, we are redoing our prior myeloma series to make sure that you, our listeners, can follow along the way you always have. In the first episode in our highly-anticipated multiple myeloma series, we begin our discussion about introduction to testing/workup for plasma cell dyscrasias and having our initial discussion about monoclonal gammopathy of undetermined significance (MGUS). Contents:- What is a plasma cell ?- What is a plasma cell dyscrasia?- What is an "SPEP"?-What is "immunofixation"?-What are "serum free light chains"?-Checking UPEP-Does everyone need a bone marrow biopsy and/or additional workup?-What is MGUS?** Want to review the show notes for this episode and others? Check out our website: Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube

Welcome to OncLive On Air®! OncLive On Air is a podcast from OncLive®, which provides oncology professionals with the resources and information they need to provide the best patient care. In both digital and print formats, OncLive covers every angle of oncology practice, from new technology to treatment advances to important regulatory decisions. In today's episode, we had the pleasure of speaking with Joshua Richter, MD, about the rationale and implications for the phase 1 CAMMA 1 study (NCT04910568), which is investigating the bispecific antibody cevostamab (RG6160; BFCR4350A) in patients with relapsed/refractory multiple myeloma. Dr Richter is an associate professor of medicine at The Tisch Cancer Institute and director of Multiple Myeloma at the Blavatnik Family Chelsea Medical Center at Mount Sinai in New York, New York. In our exclusive interview, Dr Richter discussed the rationale for targeting FcRH5 in the development of therapies for multiple myeloma, the evaluation of cevostamab-based combination strategies in patients with relapsed/refractory disease, and what the future may hold in this research arena. 

In today's episode, we had the pleasure of speaking with Marc S. Raab, MD, about the post-induction outcomes and updated minimal residual disease (MRD) analyses from the phase 2 MajesTEC-5 study (NCT05695508), which is evaluating teclistamab-cqyv (Tecvayli)–based induction regimens in patients with newly diagnosed multiple myeloma. Dr Raab is a professor of medicine at Heidelberg University in Germany.

In today's episode, we had the pleasure of speaking with Sikander Ailawadhi, MD, and Beth Faiman, PhD, MS, APN-BC, BMTCN, AOCN, FAAN, FAPO, about the potential clinical implications of the phase 3 IRAKLIA (NCT05405166) and phase 2 IZALCO (NCT05704049) studies, which investigated the use of isatuximab-irfc (Sarclisa) administered via an on-body delivery system in patients with relapsed/refractory multiple myeloma. Ailawadhi is a consultant in the Division of Hematology/Oncology in the Department of Internal Medicine, a consultant in the Department of Cancer Biology, and a professor of medicine at Mayo Clinic in Jacksonville, Florida. Faiman is a nurse practitioner in the Multiple Myeloma Program at Cleveland Clinic in Ohio. In our exclusive interview, Ailawadhi and Faiman discussed the rationale for efforts to bring isatuximab on-body injectors into the clinic, key patient-reported outcome findings from these studies, and how these findings may one day influence therapy administration across the broader multiple myeloma treatment paradigm.

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Michael Wang, MD For patients with mantle cell lymphoma (MCL) who relapse after BTK inhibitor (BTKi) therapy, treatment decisions can be complex and time sensitive. That's why understanding how tumor biology and risk features can guide selection between immunomodulatory regimens and CAR T-cell therapy is essential. Tune in to hear Dr. Charles Turck speak with Dr. Michael Wang about practical, evidence-based strategies for managing relapsed/refractory MCL. Dr. Wang is a Professor in the Department of Lymphoma and Myeloma in the Department of Stem Cell Transplantation at MD Anderson Cancer Center in Houston, Texas.

In this episode of Hema Now, Pieter Sonneveld, Chair of the European Myeloma Network (EMN) and a leading voice in haematology, discusses how research and collaborative trials, like PERSEUS and CEPHEUS, are redefining standards of care in multiple myeloma. From the importance of early diagnosis to the evolving role of minimal residual disease testing, this conversation offers a forward-looking perspective on what's next for patients and clinicians alike.  Timestamps    00:00 – Introduction  01:36 – Initial interest in multiple myeloma  03:24 – Treatment landscape  05:25 – Minimal residual disease  08:20 – European Myeloma Network (EMN)  11:04 – Overview of the PERSEUS trial   14:37 – Overview of the CEPHEUS trial  17:45 – The future of myeloma care  20:38 – Pieter's three wishes for healthcare   

In this episode of The HemOnc Pulse, host Melissa speaks with Omar Nadeem, MD, Senior Physician at Dana-Farber Cancer Institute and Assistant Professor of Medicine at Harvard Medical School, about emerging genomic insights in smoldering multiple myeloma. The discussion focuses on recent research showing how molecular profiling can improve understanding of disease progression and refine risk stratification beyond traditional clinical models. Dr. Nadeem highlights how genomic data may help distinguish patients with smoldering myeloma who are at higher risk of progression from those likely to remain stable, offering the potential to guide more personalized treatment decisions. The conversation also explores the evolving landscape of precursor plasma cell disorders and the role of immunotherapy, including CAR T-cell therapy, in clinical management.      

This episode provides comprehensive coverage of key clinical trial updates from the 2025 International Myeloma Society (IMS) Annual Meeting in Toronto, with special focus on bispecific antibodies and novel immunotherapies across the multiple myeloma disease continuum—from smoldering disease through relapsed/refractory settings. Dr. Alfred Garfall provides expert commentary on study design, efficacy, safety considerations, and clinical implications.Topics Covered1. SMOLDERING MULTIPLE MYELOMALINKER-SMM1Phase 2, open-label study of linvoseltamab monotherapy (200 mg) in patients with high-risk smoldering multiple myeloma by 20/2/20 or PETHEMA criteria, with 2-year treatment duration.Discussion Points:Appropriateness of 2-year treatment duration for precursor conditionEfficacy and MRD-negative ratesSafety considerations in asymptomatic populationPatient selection if available today2. NEWLY DIAGNOSED MULTIPLE MYELOMAMajesTEC-5Phase 2 trial evaluating three teclistamab-daratumumab-based induction regimens in 49 transplant-eligible NDMM patients, followed by auto-transplant and fixed-duration Tec-Dara maintenance.Discussion Points:Post-induction MRD-negativity rates with Tec-DR and Tec-DVRGrade 3-5 infection rates and infection-related deathsQuestionable utility of bortezomib and need for ASCT with 100% MRD-negativityHigh infection prophylaxis requirementsMagnetisMM-6Phase 1/2 dose-finding study of fixed-dose elranatamab 76 mg Q4W with Dara-Len in 37 transplant-ineligible NDMM patients (median age 75 years).Discussion Points:VGPR or better ratesSafety profile including infections and CRS/ICANSRisk of continuous therapy in elderly/frail populationLINKER-MM4Phase 1/2 study of linvoseltamab monotherapy in NDMM with both transplant-eligible and transplant-ineligible pathways, exploring three dose levels (50, 100, 200 mg).Discussion Points:Efficacy of single-agent Linvo in NDMMWhether any NDMM population could achieve long-term control with single-agent BCMA BsAbSafety profile3. RELAPSED/REFRACTORY MULTIPLE MYELOMACAMMA-1Phase 1b randomized dose-expansion study of cevostamab (FcRH5×CD3 bispecific) combined with pomalidomide-dexamethasone in BCMA-naïve patients with median 2 prior lines of therapy.Discussion Points:Efficacy and safety resultsPositioning in treatment paradigmUse before BCMA BsAbs?Sonrotoclax + Dexamethasone in t(11;14) R/R MMPhase 1/2 study of sonrotoclax (next-generation BCL2 inhibitor) plus dexamethasone as an all-oral regimen in patients with t(11;14) R/R MM (median 3 prior lines, ~75% triple-exposed).Discussion Points:Efficacy including response rate and PFSSafety profileFuture of BCL2 inhibitors in t(11;14) myeloma in the era of BsAbs and CAR TRedirecTT-1Phase 2 trial combining teclistamab + talquetamab in 90 heavily pretreated patients with R/R extraosseous extramedullary disease (84% triple-class refractory, 36% penta-refractory, 20% prior BCMA CAR T).Discussion Points:Response rate and durability in difficult-to-treat populationSafety concerns with dual bispecific combinationOff-label use considerations4. CAR T-CELL THERAPY TOXICITIESCAR T Immune-Related Adverse Events (UPenn Study - Ho et al)Large cohort study of 198 patients (125 cilta-cel, 73 ide-cel) examining all adverse events other than CRS, ICANS, IEC-HS, and IECAHT.Discussion Points:Landscape of CAR T IRAEs: incidence, types, and timingRisk factors identified for CirAEsMechanism of toxicities and role of CD4+ CAR T-cellsClinical implications: Should prophylactic corticosteroids be used? What ALC threshold? Optimal dose/duration? Prospective studies needed?

Listen to JCO's Art of Oncology article, "A Fight Bigger Than Myeloma” by Dr. Adeel Khan, an Assistant Professor of Medicine and Public Health at UT Southwestern. The article is followed by an interview with Dr. Adeel Khan and host Dr. Mikkael Sekeres. Dr. Khan shares the story of a patient whose multiple myeloma diagnosis and treatment serves as a reminder of the civil liberties progress we've made and that we have more to go. TRANSCRIPT Narrator: A Fighter Bigger Than Myeloma, by Adeel M. Khan, MD, MPH, MS  I met her during the early part of my clinical training in hematology/oncology. She was in her late 70s, dressed in a rust-colored cardigan and a headwrap with patterns that reminded me of Ghanaian kente cloth. Her eyes were sharp, her tone polite but direct. You could tell from the moment she spoke that she had lived a life where she had to advocate—for herself, for her family, for her place in rooms that were not always welcoming.  Her chart said “multiple myeloma, R-ISS II,” but it did not say that she had first come to an emergency room at least a year earlier complaining of back pain and fatigue and had been told it was probably arthritis or old age. It did not mention that she had seen three different doctors before someone ordered the laboratory tests that finally began to work up her anemia and increasingly compromised kidney function. It would take another trio of doctors to eventually order a magnetic resonance imaging whose ghostly lytic lesions led down the path to a bone marrow biopsy and her cancer diagnosis. When I brought this up gently during one of our early appointments, she looked at me and said, “They don't hear pain the same when it comes from someone like me.” As a Black woman from the Deep South, she had grown up learning how to navigate a health care system that did not always believe her. She told me stories about being dismissed, misdiagnosed, and interrupted. She was born into an era of structural violence where she would be ignored at best and mistreated at worst. She carried the weight of those moments, but she also carried strength, and clarity, and the kind of dignity that made people sit up straighter in their leather chairs when she entered the room. She was one of the most quietly revolutionary people I have ever known, having grown up during a time of civil rights activism. She had even taken part in bending Dr King's long arc of the moral universe toward justice and could share story upon story from her glory days. Her myeloma treatments were not easy. Chemotherapy rarely is. She shared that there were days when her body was tired of fighting, when her bones ached, her blood counts dropped, and her neuropathic pain throbbed. In the back of my mind, I thought how tragic it was that her delayed diagnosis added unnecessary complications and whether she too thought of that. She was fully mindful of the issues people with her skin color faced in our American healthcare system and society as a whole and revealed how that motivated her to carry forward. “If I don't take up space here,” she told me once, “then someone else like me won't either.” Over the course of our visits, I came to understand that she did not see her myeloma as the hardest fight of her life. Not by a long shot. Her primary struggle was centered on life in Birmingham in the 1950s where separate but equal was still the law of the land; her mother cleaned houses, her father worked odd jobs, and her own prospects were uncertain. She admired the writings of Richard Wright and Jean Toomer and was not shy in sharing her passions. One day, during a particularly tough visit—her disease had progressed and we were down to limited options—I found myself meandering. We went through the usual workup and discussions: laboratory test results, symptoms, and treatment options. I offered the prospect of clinical trials, but she shook her head gently and said, “I've done my time in experiments—I can't give myself to a system that gave my people so little.” I paused. It was the first hint of what would become a larger conversation—not just about medicine, but about history. She was well aware of the atrocities of the Tuskegee syphilis trials in her home state, the Kligman experiments on incarcerated Black men, and the forced sterilization of women of color. As dependent upon medicine as she was in her old age, it carried a bloody stain of dehumanizing racism that soured her against it. Outwardly, I had little in common with her. As a young South Asian man growing up in times more conscious of racial injustice, I was far removed from these historical crimes. Although I learned of them during my education, I did not internalize their impact on the patients in front of me in clinic. But through her I came to comprehend just how scarring and enduring these events can be and how they can rob someone of trust. And the truth is the health care system had not treated her well. She had personal stories of doctors who did not believe her pain, nurses who assumed she was uneducated,  and being passed over for better options, better care, and better answers. “But I kept showing up,” she said. “Because that's what we do. We show up even when we're not wanted.” Her stories to me were revelations. In her younger years, she had helped organize teachers at her school when they tried to fire a fellow Black teacher who seemingly spoke too loud in a meeting. She had lived through redlining, through the crack epidemic, through watching young Black men vanish into prisons, and still she rose every day and worked as a public school teacher for decades. She worked for a system that largely did not work for her. I came to admire that about her—that in simply living day-to-day life with plain dignity and acute awareness of society's issues, she promoted change by living it. “You want to talk about cancer?” she once said, half laughing. “Try walking into a bank in 1972 with a good credit score and a Black face. That's a disease this country still hasn't cured.” Curiously, she did not say these things with bitterness. Not even anger, really. Just clarity. Like someone who had long ago made peace with the truth, even if it was sharp. In clinic, she challenged my every assumption—about treatment tolerance, about compliance, about who is difficult, and who is “advocating.” And she taught me to look differently at the ways bias lingers in medicine. Not just in data or policies, but in subtle moments: the tone we use when explaining options, the hesitations in our tests and referrals, and the assumptions we may not even realize we are making. And she did not just expect good care—she demanded it. She told me early on, “Don't you treat me like I'm anything other than your mother.” That landed. And in seeing patients before me now, I remind myself to wonder who they were in their past lives, what baggage burdens them, and how it all shapes their perspectives. So from my view, she fought multiple myeloma with everything she had, but from hers, she fought something bigger: an entire system shaped by inequality. And ultimately, she made me better to realize that, not just as a doctor, but as a human being. In my years since knowing her, completing my training, and beginning my practice, I reflect on her grace. I think not just about her life, but what it means to practice medicine in a world that often forgets what patients carry with them into the clinic—generations of weight, of injustice, of strength. Mikkael Sekeres: Welcome back to JCO's Cancer Stories, The Art of Oncology. This ASCO podcast features intimate narratives and perspectives from authors exploring their experiences in oncology. I'm your host, Mikkael Sekeres. I'm Professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center, University of Miami. I am so happy that today we are joined by Adeel Khan, who's Assistant Professor of Medicine and Public Health at UT Southwestern in Dallas to talk about his Journal of Clinical Oncology article, “A Fight Bigger than Myeloma.” Our guest's disclosures will be linked in the transcript. Adeel, thank you so much for contributing to JCO and for joining us to discuss your article. Adeel Khan: Thank you so much for having me. It's a pleasure to be here. Mikkael Sekeres: Adeel, I don't want to be disingenuous to our readers by acting as if we've just met. You and I have known each other for a decade since you were still in your training. I wonder if for our listeners you can tell us a little bit about yourself, where are you from and and walk us through your career so far. Adeel Khan: More than happy to. So, I grew up mostly in Oklahoma, but I've sort of lived around in the Northeast and here in the Southwest where I am currently. I did college at the University of Oklahoma. I did medical school at the University of Michigan. I did residency with good fortune at the Cleveland Clinic where I happened to get to know you and have continued to know you since. I did my fellowship then in hematology oncology at Beth Israel Deaconess in the Harvard system and along the way of all that I did a Masters of Public Health at Harvard and a Masters of Science and Epidemiology at Columbia, and that pinball finally settled here to UT Southwestern here in Dallas which I am very happy to make my second home. Mikkael Sekeres: That's great. I will say just for our listeners you've been a superstar since the moment you were a resident. It's been a real treat for me to get to know you over the years. Adeel Khan: Thank you so much. Mikkael Sekeres: Can you tell us a little bit about your own story as a writer? You're a good writer. We get submissions from some really good writers every single week. It's a real privilege to be an editor for the Art of Oncology section and it's always reinvigorating to me to see how many good writers there are in medicine. How did you start your journey as a writer and how long have you been writing reflective narrative pieces? Adeel Khan: I would say if I went back to let's say high school, you know, people tend to be divided into kind of like the sciency types versus the literary arts types and you're kind of an either/or, you know, you didn't really have as much crossover then. But you know, I actually didn't mind when we had an essay due and I liked writing back then, and when I entered college I did a minor in English because I actually did enjoy that and I just liked the idea of being able to put your thoughts on paper in a way immortalizing them. Adeel Khan: And then as I sort of pursuing medicine more and more, publishing is really- it has all kinds of flavors to it and scientific publishing is obviously what has been emphasized, but you know, there's so many things to talk about within medicine. There's the science and the art of the field, and as I've moved along, I've written different pieces focusing really on patient stories and interactions. And I think my motivation has always been that as I have gotten particularly nowadays increasingly busy, I've had the fortune and misfortune of becoming more and more busy, it's easy to lose the opportunity to really connect with people that makes what we do meaningful. And so in those times when you know, and they can be rare, but when you really get to connect with someone in front of you who you're helping to care for, it's really refreshing and it's rejuvenating and I've tried to keep that with me as long as I can as I've gone through my journey. Mikkael Sekeres: There's a lot of jumping off points from what you just said, Adeel. I wonder if I can start with do you consider yourself an English major who's good at science or do you consider yourself a scientist who's a good writer? Adeel Khan: I think I'm too humble to say either. I think I was really a science major who just happened to like writing and reading and kept that as a part of myself. Mikkael Sekeres: Because I think there are a cadre of doctors who are actually English majors and have learned to turn science into storytelling and that's their entrée into science and medicine. I remember I talked for a while with David Scadden about this. He's a brilliant translational scientist who's based at Mass General who also teaches a writing course to the Harvard undergrads and who was an English major when he was an undergrad at Case Western. We've talked about this, about how there are people, I'll include myself in this, who just think different, who probably have these liberal arts brains and they figured out a way to convert science into a way a liberal arts person can understand it. Adeel Khan: Yeah, I mean narrative medicine has been I think around all along and it has only kind of been recently named as a field, but I mean it very much speaks to that that there's so much more than just G proteins in medicine. Mikkael Sekeres: I'm thrilled to hear that by the way. You mentioned you were an English minor. Are there particular writers who are an influence on you or can you talk about what's the most recent book or article you've read? Adeel Khan: Oh, that is a great question. Paulo Coelho is someone I've liked for a long time, The Alchemist. I really liked it because I read it after I had lived in Egypt. I lived in Egypt between college and med school as a study abroad program, and I had actually been to the Faiyum Oasis where the protagonist in that story ends up. And so it was just a fascinating story to me that I could trace some of the steps that are discussed in the book and it's so much- it's a story about self discovery which at that phase of life that I was in was you know, very much a theme of my own life. And so that's one that definitely stands out in my head. Mikkael Sekeres: Do you think reading pieces outside of medicine makes you a better scientist? Adeel Khan: I think absolutely. I think it makes you a better human being. In some ways I lament that so much of what I do reading now is so much just about what's in the field, what's new in myeloma, what's new in hematology oncology and I sort of miss the escape to reading other things and being able to pursue it. And even broader than just what a novel really offers. I mean, I grew up reading comic books too and I've always loved superheroes and fiction whether it's Star Wars and other things. And really they're just stories and the medium- there might be connotations whether it's a comic book or a or a novel, but they're just different mediums, but the fact that they're just stories is fundamental. I actually think to myself that it's so fascinating that the earliest piece of writing that we've really retained as human beings is we believe, the Epic of Gilgamesh, which is really a story of a superhero when you think about it, you know, and it's it's fiction, it's phantasmic in so many ways. But it speaks to how stories are just vital as people. Mikkael Sekeres: And what is it about graphic novels or my kids now of course call them graphic novels. We're not allowed to call them comic books. Adeel Khan: As they've been renamed, yeah. Mikkael Sekeres: What is it about graphic novels or comic books or the story of a hero that appeals to us in medicine? Adeel Khan: I think it's in some ways a parable of what we're doing. There's something so powerful and fundamental about this idea of good-evil and we can rename it in different ways, but that you're trying to overcome something that's an issue, an obstacle. And when you think about what we do in- particularly in oncology, that's very much what we're trying to do. We're trying to overcome an illness, a disease, to try to help the person in front of us. And it has different aspects to it. It could be someone pursuing something in a lab, it can be treating someone in front of you in clinic, but that simple dichotomy of there's something good about what you're doing because there's something bad in front of you is just the fundamental that runs through it all. Mikkael Sekeres: It's fascinating. I wonder if 30, 40, 50 years ago people would have said, “Oh, it's because the doctor is the hero,” but we don't view ourselves that way anymore. The patient is the hero. I love how you posit this as a good versus evil, the evil of course being cancer and the good everything that our patients do and that we try to to help to do to overcome that. Adeel Khan: For sure. Mikkael Sekeres: You wrote a really great essay about a woman who was a patient of yours. Can you tell me a little bit about what inspired you this time to make this connection and to write about this woman? Adeel Khan: Within the past year or so as I had been just really- the fortune and misfortune of getting busier, I lamented that I just wasn't able to spend as much time with patients in the way that I used to. One of the beauties of medical school and you know, to some degree residency and certainly fellowship is that you just have a little bit more time as a trainee, student and trainee where you can really bond with your patients I think a little bit more. And so in trying to kind of refresh my motivation, I was thinking about just kind of randomly some stories that I've kept in the back of my mind and this patient's story is one that stood out to me as I was recalling things. It was so fascinating to me because she had the disease which I now focus on. And the way that she viewed it and the way that she viewed it as a part of her life was just so different than what I think most people think of. And in that way it was very revitalizing that her focus in her life was part of a broader theme of the way that I think she viewed society. And this was just one piece of her own part of that much, much larger puzzle. Mikkael Sekeres: You really write lovingly about her and about how meaningful her context was in how you cared for her and what her experience was in the medical system. I wonder if I can read a little bit of what you wrote because it really did grab me as well. I'm going to start out by quoting you where you say, “Outwardly, I had little in common with her. As a young South Asian man growing up in times more conscious of racial injustice, I was far removed from these historical crimes. Though I learned of them during my education, I did not internalize their impact on the patients in front of me in clinic. But through her, I came to comprehend just how scarring and enduring these events can be and how they can rob someone of trust.” Wow, there's a lot there. Could you start with what was your perspective as a young South Asian man growing up in Oklahoma and what your view was of racial injustice compared to what her experience was of racial injustice? Adeel Khan: Yeah, I have to admit I don't know that I thought that much of it back then and I think that that's part of what it is. You know, being someone who was South Asian, I'm Pakistani, I have Indian roots, and coming into American history and as we learned about it there's so much about slavery and the theme of slavery unfortunately and and the struggles that enslaved peoples have. And you know, as a relatively recent immigrant, I didn't see myself in that narrative. I didn't see myself in that historical reality. But I knew about it intellectually, you know, I knew about the Tuskegee Syphilis Experiments, you know, I learned about all these things and and you learned about how atrocious so much of it is. But again, not being so directly connected, I did not put myself in that same role as someone to view it so close to myself. I will say it hit a little bit more after 9/11 when you know, I was randomly stopped at airport security a little bit more often in those days and again, I think that speaks to racial injustices, you know, I was certainly profiled looking back then, I've been held by TSA in the past, but even that is very minor compared to what African Americans have dealt with here. And this patient in just kind of sharing her tidbits during our time together, I was not directly asking her so much of this. She was really offering a lot of it to me as we would talk and she would be very generous in sharing parts of her story. And over time I kind of understood the broader narrative of her life. You know, it was clear how much of all that was actually in the forefront of her head. Adeel Khan: And I think she might have been a little bit more unique in the way that she kept it there, but she was hyper vigilant of issues of society and the roots that brought a given society to where it is here. I kind of got to know her, this is during the COVID pandemic and this was after the injustice of what happened to George Floyd and so it was a theme that I think people were talking about more and so I think she felt comfortable in saying really what was quite a bit that was stewing in the back of her head seemingly at all times. Mikkael Sekeres: It's so interesting you talk about what you endured after 9/11 as being, I'm going to quote you now, “minor” compared to what she's been through, but even a minor affront like that can really compromise your trust. You write about her, “As a Black woman from the deep South, she had grown up learning how to navigate a healthcare system that did not always believe her.” Can you expand on that a little bit? How is it that the healthcare system didn't believe her and what can we do going into interactions with patients from different backgrounds where we're incorporating that there's a compromise of trust and we have to make up for that? Adeel Khan: Yeah, and I think you know, it's so unfortunate that so many people have stories like this where, in her case really it was back pain that was her presenting symptom. This is long before she knew me. And she'd had the back pain for quite some time, but being an older woman, she was in her 70s at that time, she was not in phenomenal health for other reasons. It sounds like she was just kind of ignored, told that it was old age, tendon changes, she did not have meaningful imaging for some time. When she finally did after seeing a slew of different providers, that's when it was revealed like there's something more significant here. And then when you kind of piece that a little bit retrospectively and I think she certainly sensed this and I did when I- hindsight's always 20/20, when I looked through things, it's like, well, this probably could have been caught much earlier. It's just that no one really I think listened to what she was speaking to with her pain and the gravity that was actually behind it. And it just speaks to the fact that I think we have to be more thoughtful in what we take away from patients and not to ignore even small comments because they might be revealing of something much bigger behind them. Mikkael Sekeres: You quote her, you have some really great quotes in your essay where you just listen to what she says and transcribe it because what she says is very meaningful. And one of the quotes you provide from her is, “They don't hear pain the same when it comes from someone like me.” Wow. “When it comes from someone like me,” someone like her, how was it that people weren't hearing her description of pain, something that was different that was going on in her body and how can we be more attentive to people when they complain about things like pain? Adeel Khan: It's unfortunate that there's even known data to show how depending upon a patient's melanin content in their skin, how likely they are to get pain medications and what happens to them is different and this is an unfortunate example of that where I think she just wasn't heard properly. And so it wasn't addressed properly and she was not shy about saying that. I mean I think she sensed that. She was very clear in feeling that herself and in wanting to have better care, she was still prevented and hence why she had to go from provider to provider. Mikkael Sekeres: You've lived in a bunch of different places in the country. I mean, following your path, you've been in Oklahoma, you've been in Michigan, Ohio, Massachusetts, and now Texas. Do you think that we as providers have to have different levels of sensitivity depending on where in the country we're practicing and how some of our patients' trust in healthcare may have been compromised in those different parts of the country? Adeel Khan: I think absolutely. I mean this particular patient was from Alabama which has a heavy history that she was again very aware of and for those of us reading history books are also very aware of too. And it's interesting how, while the U.S. is in some ways- has some aspects that are monolithic, but it's very much not so. It's very patchy and people are different, you know, if I take one theme that we're talking about here is obviously racial injustice, but if you take something like obesity, you know, prevalence rates are very different throughout the country and attitudes surrounding it are also very different. And I think we do- ought to be mindful that in treating the patient in front of us, it's not done without context. And so how they view their illness and their situation is going to be different depending upon the state, depending upon the city, depending upon actually even the era that they grew up in. So I would say now, if you took actually a similar patient, but you put her in a very modern context post-year 2000, she's likely to have different feelings of the situation around her than someone who was born in this case in the 1940s. And that just speaks to the fact that circumstances change and we should be recognizing that as providers, even though it's not always easy to. Mikkael Sekeres: Well, it just emphasizes how very important it is to know the history of the place where we practice and how it's affected our patients' perceptions of healthcare and trust and being cared for, particularly now as there's such a movement to whitewash that history and eliminate it from major institutions like the Smithsonian. It has been such a pleasure to have Adeel Khan here. He is Assistant Professor of Medicine, Public Health at UT Southwestern in Dallas and wrote just a great JCO article called “A Fight Bigger Than Myeloma.” Adeel, thank you so much for submitting your article and for joining us today. Dr. Adeel Khan: Thank you so much for having me. It's been a pleasure. Mikkael Sekeres: If you've enjoyed this episode, consider sharing it with a friend or colleague or leave us a review. Your feedback and support helps us continue to have these important conversations. If you're looking for more episodes and context, follow our show on Apple, Spotify, or wherever you listen and explore more from ASCO at ASCO.org/podcasts. Until next time, this has been Mikkael Sekeres for JCO Cancer Stories: The Art of Oncology. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Show Notes Like, share and subscribe so you never miss an episode and leave a rating or review.  Guest Bio: Dr Adeel Khan is an Assistant Professor of Medicine and Public Health at UT Southwestern.

This episode provides timely coverage of the 2025 Meeting of the International Myeloma Society (IMS). Claudio Cerchione highlights the most important developments from the Annual Meeting, offers his reflections on the evolving treatment landscape, and discusses the role of research and collaboration in moving closer to a cure for myeloma.  Timestamps   00:00 – Introduction  02:08 – Reflections on his own career  04:20 – Claudio's initial interest in the field  06:46 – Key takeaways from IMS 2025 Meeting  10:09 – Any potential gaps in coverage?  11:50 – How different patient groups are identified  13:30 – Minimal residual disease  16:15 – Impact of medical societies  20:24 – Translating new findings into clinical practice  23:44 – Improving the accessibility of treatments  26:45 – Claudio's key takeaways from IMS 2025 Meeting  Disclaimer: The opinions expressed in this episode belong to the speakers and do not necessarily represent the opinions of EMJ. 

Blood cancer patients are being forced to move to Australia to access life prolonging drugs that are not funded in Aotearoa. Daratumumab, or dara, can help prolong the lives of people with the blood cancer myeloma but costs hundreds of thousands of dollars, while it is virtually free in Australia. Jo Neep was diagnosed with Myeloma in 2017 and moved to Australia to access funded Dara treatment, she spoke to Lisa Owen.

Prior to the election, Christopher Luxon made a commitment to fund a list of hard tumour cancer medications. At the same time National repeatedly promised that blood cancer sufferers would not be forgotten. But two years on from that promise, many of them do feel forgotten. The drug Daratumumab, or Dara is on Pharmac's priority drug list. That's the list of drugs it would like to fund, but can't afford. Dara is virtually free in Australia, but costs hundreds of thousand of dollars here. That means some desperate blood cancer patients are funding it themselves; relying on the kindness of others and donation pages. Aucklander Geoff Dawson, has multiple Myeloma, and is on Dara, he spoke to Lisa Owen.

Host Rahul Banerjee, MD, speaks with Drs. Frederik Schjesvold and Frida Askeland on myeloma trial results, relevance in the IMROZ/CEPHEUS era, and advances in treating elderly, frail patients.

Joseph Mikhael, chief medical officer of The International Myeloma Foundation, and his organization are pulling all the stops to find a true cure for multiple myeloma, a rare and often fatal blood cancer. He shares the origins and mission of the Black Swan Research Initiative, a research project dedicated to preventing myeloma and finding a cure, and how global collaborators are contributing to multiple myeloma research. Also, host Deborah Borfitz delivers the latest news on ChatGPT determining trial eligibility, a questionable shortcut in rectal cancer drug trials, a new no-nausea weight loss remedy heading to trial, and more. News Roundup AI for stratifying Alzheimer's patients Study in Nature Communications  Questionable shortcut in rectal cancer drug trials Investigation in JAMA Network Open ChatGPT determines trial eligibility Paper in Machine Learning: Health Major trauma study to test hemorrhage treatment News release by University of Colorado Anschutz Medical Campus New weight loss remedy soon heads to trials News on Syracuse University website Study in Science Translational Medicine The Scope of Things podcast explores clinical research and its possibilities, promise, and pitfalls. Clinical Research News senior writer, Deborah Borfitz, welcomes guests who are visionaries closest to the topics, but who can still see past their piece of the puzzle. Focusing on game-changing trends and out-of-the-box operational approaches in the clinical research field, the Scope of Things podcast is your no-nonsense, insider's look at clinical research today.

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Sairah Ahmed, MD CAR T-cell therapies have helped transform the treatment of aggressive lymphomas, but could they also change the game for slower-growing, harder-to-treat diseases like marginal zone lymphoma? Based on new data from the TRANSCEND FL study, liso-cel achieved a 95 percent overall response rate and sustained 24-month progression-free survival in relapsed/refractory marginal zone lymphoma. Here with Dr. Charles Turck to share the key efficacy and safety findings is Dr. Sairah Ahmed, Professor in the Department of Lymphoma and Myeloma and CAR T Program Director at MD Anderson Cancer Center.

Featuring perspectives from Dr Natalie S Callander and Dr Sagar Lonial, including the following topics:  Introduction (0:00) A Farmer with Myeloma; Is Myeloma the New Chronic Myeloid Leukemia? (2:06) Clinical Trials (12:34) Chimeric Antigen Receptor Therapy (16:11) Bispecific Antibodies (21:38) Antibody-Drug Conjugates; a Patient on Belantamab Mafodotin for 3 Years (30:45) Treatment Options for Relapsed Disease (40:46) Neuropathy (44:43) Alternative Therapies (48:36) 164 Questions (53:20) CME information and select publications

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/WMD865. CME credit will be available until August 20, 2026.At the Nexus of Sequential Care in Myeloma: Interprofessional and Patient Perspectives on GPRC5D-Directed Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/WMD865. CME credit will be available until August 20, 2026.At the Nexus of Sequential Care in Myeloma: Interprofessional and Patient Perspectives on GPRC5D-Directed Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/WMD865. CME credit will be available until August 20, 2026.At the Nexus of Sequential Care in Myeloma: Interprofessional and Patient Perspectives on GPRC5D-Directed Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/WMD865. CME credit will be available until August 20, 2026.At the Nexus of Sequential Care in Myeloma: Interprofessional and Patient Perspectives on GPRC5D-Directed Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/WMD865. CME credit will be available until August 20, 2026.At the Nexus of Sequential Care in Myeloma: Interprofessional and Patient Perspectives on GPRC5D-Directed Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/WMD865. CME credit will be available until August 20, 2026.At the Nexus of Sequential Care in Myeloma: Interprofessional and Patient Perspectives on GPRC5D-Directed Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

In this Editor's Special Episode of The HemOnc Pulse, Dr. Hira Mian of McMaster University shares expert insights on the evolving treatment landscape for multiple myeloma. From optimizing selinexor use, to understanding long-term MonumenTAL-1 data with talquetamab, to the promise of emerging trispecific antibodies, Dr. Mian highlights the biggest shifts shaping care today.

Please visit answersincme.com/NPK860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in multiple myeloma (MM) answers common questions about incorporating novel cereblon E3 ligase modulators (CELMoDs) in early-relapse therapy for patients with MM. Upon completion of this activity, participants should be better able to: Identify the rationale for incorporating novel CELMoDs in early-relapse therapy in patients with MM; Discuss the clinical impact of the latest data for emerging novel CELMoDs in the early-relapse setting for patients with MM; and Describe potential considerations for integrating novel CELMoDs in the treatment landscape of MM as they become available.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete NCPD information, and to apply for credit, please visit us at PeerView.com/ZNS865. NCPD credit will be available until July 29, 2026.Leading the Next Chapter of Myeloma Care: Oncology Nurse Stewardship in the Era of Innovative Antibodies and Cellular Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis educational activity is supported by independent medical education grants from AbbVie, GSK, and Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete NCPD information, and to apply for credit, please visit us at PeerView.com/ZNS865. NCPD credit will be available until July 29, 2026.Leading the Next Chapter of Myeloma Care: Oncology Nurse Stewardship in the Era of Innovative Antibodies and Cellular Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis educational activity is supported by independent medical education grants from AbbVie, GSK, and Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete NCPD information, and to apply for credit, please visit us at PeerView.com/ZNS865. NCPD credit will be available until July 29, 2026.Leading the Next Chapter of Myeloma Care: Oncology Nurse Stewardship in the Era of Innovative Antibodies and Cellular Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis educational activity is supported by independent medical education grants from AbbVie, GSK, and Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete NCPD information, and to apply for credit, please visit us at PeerView.com/ZNS865. NCPD credit will be available until July 29, 2026.Leading the Next Chapter of Myeloma Care: Oncology Nurse Stewardship in the Era of Innovative Antibodies and Cellular Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis educational activity is supported by independent medical education grants from AbbVie, GSK, and Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete NCPD information, and to apply for credit, please visit us at PeerView.com/ZNS865. NCPD credit will be available until July 29, 2026.Leading the Next Chapter of Myeloma Care: Oncology Nurse Stewardship in the Era of Innovative Antibodies and Cellular Therapies In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and HealthTree Foundation for Multiple Myeloma. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis educational activity is supported by independent medical education grants from AbbVie, GSK, and Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.

In this JCO Article Insights episode, Michael Hughes summarizes “International Myeloma Society and International Myeloma Working Group Consensus Recommendations on the Definition of High-Risk Multiple Myeloma" by Avet-Loiseau et al. published on June 09, 2025 along with an interview with author Dr Nikhil C. Munshi, MD. TRANSCRIPT Michael Hughes: Welcome to this episode of JCO Article Insights. This is Michael Hughes, JCO's editorial fellow. Today I am interviewing Dr. Nikhil Munshi on the “International Myeloma Society and International Myeloma Working Group Consensus Recommendations on the Definition of High-Risk Multiple Myeloma” by Avet-Loiseau et al. At the time of this recording, our guest has disclosures that will be linked in the transcript. While some patients with multiple myeloma live for decades after treatment, others exhibit refractory or rapidly relapsing disease irrespective of treatment administered. We term this “high-risk myeloma.” Multiple risk stratification systems have been created, starting with the Durie-Salmon system in 1975 and evolving with the advent of novel therapeutics and novel treatment approaches. In 2015, the Revised International Staging System (R-ISS) was introduced, which incorporated novel clinical and cytogenetic markers and remained, until recently, a mainstay of risk stratification in newly diagnosed disease. Myeloma as a field has, just in the past few years, though, undergone explosive changes. In particular, we have seen groundbreaking advances not only in treatments - the introduction of anti-CD38 agents and the advent of cellular and bispecific therapies - but also in diagnostic technology and our understanding of the genetic lesions in myeloma. This has led to the proliferation of numerous trials employing different definitions of high-risk myeloma, a burgeoning problem for patients and providers alike, and has prompted attempts to consolidate definitions and terminology. Regarding cytogenetic lesions, at least, Kaiser et al's federated meta-analysis of 24 therapeutic trials, published here in the JCO in February of 2025 and recently podcasted in an interview with associate editor Dr. Suzanne Lentzsch, posited a new cytogenetic classification system to realize a shared platform upon which we might contextualize those trial results. This article we have here by Dr. Avet-Loiseau, Dr. Munshi, and colleagues, published online in early June of this year and hot off the presses, is the definitive joint statement from the International Myeloma Society (IMS) and the International Myeloma Working Group (IMWG). What is high-risk multiple myeloma for the modern era? The IMS and IMWG Genomics Workshop was held in July 2023 and was attended by international myeloma experts, collaborating to reach consensus based on large volumes of data presented and shared. The datasets included cohorts from the Intergroupe Francophone du Myélome (IFM); the HARMONY project, comprised of multiple European academic trials; the FORTE study, findings from which solidified KRd as a viable induction regimen; the Grupo Español de Mieloma Múltiple (GEM) and the PETHEMA Foundation; the German-Speaking Myeloma Multicenter Group (GMMG); the UK-based Myeloma XI, findings from which confirmed the concept of lenalidomide maintenance; Emory 1000, a large, real-world dataset from Emory University in Atlanta; the Multiple Myeloma Research Foundation Clinical Outcomes in Multiple Myeloma to Personal Assessment of Genetic Profile (CoMMpass) dataset; and some newly diagnosed myeloma cohorts from the Mayo Clinic. Data were not pooled for analyses and were assessed individually - that is to say, with clear a priori understanding of whence the data had been gathered and for what original purposes. Consensus on topics was developed based on the preponderance of data across studies and cohorts. In terms of results, substantial revisions were made to the genomic staging of high-risk multiple myeloma, and these can be sorted into three major categories: A) alterations to the tumor suppressor gene TP53; B) translocations involving chromosome 14: t(14;16) (c-MAF overexpression), t(14;20) (MAFB overexpression), and t(4;14) (NSD2 overexpression); and C) chromosome 1 abnormalities: deletions of 1p or additional copies of 1q. In terms of category A, TP53 alterations: Deletion of 17p is present in up to 10% of patients at diagnosis and is enriched in relapsed or refractory disease. This is well-documented as a high-risk feature, but the proportion of the myeloma cells with deletion 17p actually impacts prognosis. GEM and HARMONY data analyses confirmed the use of 20% clonal cell fraction as the optimal threshold value for high-risk disease. That is to say, there must be the deletion of 17p in at least 20% of the myeloma cells on a FISH-analysis of a CD138-enriched bone marrow sample to qualify as high-risk disease. TP53 mutations can also occur. Inactivating mutations appear to have deleterious effects similar to chromosomal losses, and the biallelic loss of TP53, however it occurs, portends particularly poor prognosis. This effect is seen across Myeloma XI, CoMMpass, and IFM cohorts. Biallelic loss is rare, it appears to occur in only about 5% of patients, but next-generation sequencing is nevertheless recommended in all myeloma patients. Category B, chromosome 14 translocations: Translocation t(14;16) occurs in about 2% to 3% of patients with newly diagnosed disease. In the available data, primarily real-world IFM data, t(14;16) almost always occurs with chromosome 1 abnormalities. Translocation t(4;14) occurs in about 10% to 12% of newly diagnosed disease, but only patients with specific NSD2 alterations are, in fact, at risk of worse prognosis, which clinically appears to be about one in every three of those patients. And so together, the CoMMpass and Myeloma XI data suggest that translocation t(4;14) only in combination with deletion 1p or gain or amplification of 1q correlates with worse prognosis. Translocation t(14;20) occurs in only 2% of newly diagnosed disease. Similar to translocation t(4;14), it doesn't appear to have an effect on prognosis, except if the translocation co-occurs with chromosome 1 lesions, in which case patients do fare worse. Overall, these three translocations - t(14;16), t(4;14), and t(14;20) - should be considered high-risk only if chromosome 1 aberrations are also present. In terms of those chromosome 1 aberrations, category C, first deletions of 1p: Occurring in about 13% to 15% of newly diagnosed disease, deletion 1p eliminates critical cell checkpoints and normal apoptotic signaling. In the IFM and CoMMpass dataset analyses, biallelic deletion of 1p and monoallelic deletion of 1p co-occurring with additional copies of 1q denote high-risk. In terms of the other aberration in chromosome 1 possible in myeloma, gain or amplification of 1q: This occurs in up to 35% to 37% of newly diagnosed disease. It upregulates CKS1B, which is a cyclin-dependent kinase, and ANP32E, a histone acetyltransferase inhibitor. GEM and IFM data suggest that gain or amplification of 1q - there was no clear survival detriment to amplification - is best considered as a high-risk feature only in combination with the other risk factors as above. Now, in terms of any other criteria for high-risk disease, there remains one other item, and that has to do with tumor burden. There has been a consensus shift, really, in both the IMS and IMWG to attempt to develop a definition of high-risk disease which is based on biologic features rather than empirically observed and potentially temporally dynamic features, such as lactate dehydrogenase. Beta-2 microglobulin remains an independent high-risk indicator, but care must be taken when measuring it, as renal dysfunction can artificially inflate peripheral titers. The consensus conclusion was that a beta-2 microglobulin of at least 5.5 without renal failure should be considered high-risk but should not preclude detailed genomic profiling. So, in conclusion, the novel 2025 IMS-IMWG risk stratification system for myeloma is binary. It's either high-risk disease or standard-risk disease. It's got four criteria. Number one, deletion 17p and/or a TP53 mutation. Clonal cell fraction cut-off, remember, is 20%. Or number two, an IGH translocation - t(4;14), t(14;16), t(14;20) - with 1q gain and/or deletion of 1p. Or a monoallelic deletion of 1p with 1q additional copies or a biallelic deletion of 1p. Or a beta-2 microglobulin of at least 5.5 only when the creatinine is normal. This is a field-defining work that draws on analyses from across the world to put forward a dominant definition of high-risk disease and introduces a new era of biologically informed risk assessment in myeloma. Now, how does this change our clinical approach? FISH must be performed on CD138-enriched samples and should be performed for all patients. Next-generation sequencing should also be performed on all patients. Trials will hopefully now begin to include this novel definition of high-risk multiple myeloma. It does remain to be seen how data from novel therapeutic trials, if stratified according to this novel definition, will be interpreted. Will we find that therapies being evaluated at present have differential effects on myelomas with different genetic lesions? Other unanswered questions also exist. How do we go about integrating this into academic and then community clinical practice? How do we devise public health interventions for low-resource settings? To discuss this piece further, we welcome the esteemed Dr. Nikhil Munshi to the podcast. Dr. Munshi is a world-renowned leader in multiple myeloma and the corresponding author on this paper. As Professor of Medicine at Harvard Medical School, Director of the Multiple Myeloma Effector Cell Therapy Unit, and Director of Basic and Correlative Science at the Jerome Lipper Multiple Myeloma Center of the Dana-Farber Cancer Institute, he has presided over critical discoveries in the field.  Thank you for joining us, Dr. Munshi. Dr. Nikhil Munshi: Oh, it's my pleasure being here, Michael, to discuss this interesting and important publication. Michael Hughes: I had a few questions for you. So number one, this is a comprehensive, shall we say, monumental and wide-ranging definition for high-risk myeloma. How do you hope this will influence or impact the ways we discuss myeloma with patients in the exam room? And how do we make some of these components recommended, in particular next-generation sequencing, feasible in lower-resource settings? Dr. Nikhil Munshi: So those are two very important questions. Let's start with the first: How do we utilize this in our day-to-day patient care setting? So, as you know well, we have always tried to identify those patients who do not do so well with the current existing treatment. And for the last 30 years, what constitutes a myeloma of higher risk has continued to change with improvement in our treatment. The current definition basically centers around a quarter of the patients whose PFS is less than 2 to 3 years. And those would require some more involved therapeutic management. So that was a starting point of defining patients and the features. As we developed this consensus amongst ourselves - and it's titled as “International Myeloma Society, International Myeloma Working Group Consensus Recommendation” - this IMS-IMWG type of recommendation we have done for many years, improvising in various areas of myeloma care. Now, here, we looked at the data that was existing all across the globe, utilizing newer treatment and trying to identify that with these four-drug regimens, with transplant and some of the immunotherapy, which group of patients do not do as well. And this is where this current algorithm comes up. So before I answer your question straight, “How do we use it?” I might like to just suggest, “What are those features that we have identified?” There are four features which constitute high-risk disease in the newer definition. Those with deletion 17p with 20% clonality and/or TP53 mutation. Number two, patients with one of the translocations - t(4;14), t(14;16), or t(14;20) - co-occurring with 1q amplification or deletion 1p32. And that's a change. Previously, just the translocation was considered high-risk. Now we need a co-occurrence for it to be called high-risk. The third group is patients having biallelic deletion 1p32 or monoallelic deletion 1p32 along with 1q amplification. And finally, patients with high beta-2 microglobulin, more than or equal to 5.5 mg/dL, with normal creatinine less than 1.2 mg/dL. And the question, “How do we use this?” There are multiple areas where we incorporate high-risk features in our treatment algorithm. One of the first areas is where we would consider the induction regimen. If a patient has a high-risk disease, we would definitely consider a four-drug regimen rather than a three-drug regimen, although we are beginning to incorporate four-drug for all groups. That's one important thing. Number two, those are the patients where we do consider consolidation with transplant or maybe in the new world, considering some of the immunotherapeutic consolidation more early or more aggressively. Number three, these are the patients who get a little bit more maintenance therapy. So normally, lenalidomide might end up being our standard maintenance regimen. In patients who have high-risk disease, we incorporate either addition of daratumumab or the anti-CD38 targeting antibody and/or addition of proteasome inhibitor, either bortezomib or carfilzomib. So you would have multi-drug maintenance therapy in these patients. And in high-risk patients, we follow them with maintenance longer periods of time. One very critically important point to keep in mind is that to get the better outcome in high-risk disease, we must try to get them into MRD negativity because there is clear data that patients who do achieve MRD negativity, despite having high-risk disease, have a much superior outcome. They become near to standard-risk disease. And so, in high-risk patients, I would try to do whatever various options I have to try and get them into MRD-negative status. And when these patients relapse, we do not wait for the classic progression criteria to be met before we intervene. We would propose and suggest that we intervene earlier before the disease really blasts off. And so there are a number of areas in our setting where this high-risk definition will help us intervene appropriately and also with appropriate aggressiveness to achieve better outcome, to make this similar to standard-risk disease. Michael Hughes: Thank you, Dr. Munshi. And thoughts on how to really integrate this not only into academic centers but also lower-resource settings? Dr. Nikhil Munshi: So that's a very important question, Michael. And when we were developing this consensus, we were very cognizant of that fact. So wherever available, I think we are recommending that over a period of next 2, 3, 5 years, we should begin to switch over to sequencing-based methods because two components of this definition, one is TP53 mutation, which we cannot do without sequencing, and also reliably detecting deletion 1p requires sequencing-based method. So in the low-resource countries - and there are many in this world, and also even in our own country, patients may not be able to afford it - the older method with FISH or similar such technology, which is more affordable, is also acceptable for current time. They may miss a very small number of patients, maybe 2% to 3%, where these finer changes are not picked up, but a majority of this would be captured by them. So the current practice might still be applicable with some limitation in those patient populations, and that's what we would recommend. What is happening, fortunately, is that actually sequencing-based method is becoming cheaper. And in many centers, it is cheaper to do the sequencing rather than to do the FISH analysis. And so my hope is that even in low-resource centers, sequencing might be more economical in the end. It's, I think, the access to technology, which is a little bit limited currently, but it's hopefully becoming available soon. Michael Hughes: Thank you, Dr. Munshi. And staying for a minute and looking at the multiple myeloma subsets which might be missed by this really still very broad-ranging high-risk definition, at least by prior risk stratification systems, right, there is this group of patients who have standard-risk cytogenetics by R-ISS or R2-ISS, but they have primary refractory disease or they relapse early. We call these, as you are well aware, functionally high-risk disease. What proportion of previously FHR, functionally high-risk, myeloma patients do you expect to be captured by this novel definition? Dr. Nikhil Munshi: So I think the newer definition - and we can look at it both ways, but the newer definition should capture most of the functionally high-risk definition. To put it differently, Michael, there are patients who we know are, as you mentioned, functionally high-risk. Those are the patients who might have plasma cell leukemia, those who might have extramedullary disease, those who might not respond to our four-drug induction. If you don't respond to the four-drug induction, almost by definition, they are high-risk. However, a majority of them have one of the abnormalities that we are describing here. There would be a very small proportion which may not have. And if they do not have, we know one of the important components of this definition here is also that the genome, we know, keeps on evolving. So there may be a very small clone with the high-risk feature which was not obvious in the beginning. Following treatments or following relapse, that clone predominates, and now the patient's disease becomes high-risk.  So the definition would incorporate or would capture these functional high-risk patients, but as you said, in countries where resources are not available, using this functional high-risk would also be helpful and advantageous. Sometimes LDH ends up being a high-risk. In our studies, LDH has not come out to be high-risk anymore because the features we are describing captures most of those patients, but those alternatives, older, can still be considered if other newer techniques are not available. Michael Hughes: Got you. And in terms of these older definitions, yes, that incorporate tumor burden, these empirical observations about how myeloma presents, do you foresee any additional tumor burden indicators being added to future definitions of high-risk disease? Or do you instead see this particular definition as a major waypoint on the journey towards a fully biologically grounded definition of high-risk disease? Dr. Nikhil Munshi: I think your second part is what is going to happen. I think the tumor burden-related definition is being now replaced by the biological or genomic-based definition. And I think at some point, it will be quite fully replaced. One component not here, and it is because one thing, we don't have enough data; number two, we don't know how it will pan out, is also the influence of the microenvironment on the risk definition. For example, the immune system, the immune function, etc. But not enough data exists to suggest how it would change the current definition. So in future, would a definition be totally genomic or it could be more integrative? And my personal guess is that it would be more integrative and that some immune features might come into the picture, especially now that we are using immune-based therapy as a very important component of treatment - CAR T-cells, bispecific, and antibody-based treatments. What role the immune system plays in either supporting tumor or what role suppression of the anti-tumor immunity plays? They all will be important how patient outcomes end up being, and which in turn could translate into how patient's risk stratification might happen. So I think the older tumor burden-related definitions probably will become things of the past. What we have currently proposed and consensus developed is the new path forward, and over time, some microenvironmental influences, if defined and found to be important, may get some more incorporation if it compares favorably with the genomic features. Michael Hughes: Thank you, Dr. Munshi for that enlightening response.  To conclude the podcast, I'd like to look to the future and to the immediate future, what are the next steps for high-risk disease definition between now and discussing an integrated genomic-microenvironment-based definition? Will we see attempts to refine? Will we see a multi-level system, things like this? Dr. Nikhil Munshi: Yeah, so I think the current definition will be here to stay for the next 10 years or so. I think this has been developed using a large amount of data, so we do believe that this will remain fine. It has been validated now within the last six months by a few of the other studies. So there won't be a quick change. But we will try to, all of us will try to innovate. And as you very rightly bring up, the areas of research would include looking at the expression or transcriptomic component. Does that matter? And we do believe a small number of patients will have transcriptomic changes, not looked at the DNA changes, and may play a role. There are newer components, so long non-coding RNA, for example, is going to be an important component to look at, how it impacts the disease outcome, etc. There are also some of the proteomic-related changes which may become important in our studies. And then as we discussed, microenvironment and immunological changes. So these are the future areas of ongoing research where we all should collect data, and then in the next 5 to 10 years, we'll have another group meeting to see has anything changed or any of the features have become more important.  Most of the time, some of the older features are lost because they are not as critically high-risk, and the newer features come in. And so the historical background for just one second, there was a time when chromosome 13 was considered a high-risk disease. We now don't even mention it because it's not high-risk. The newer treatments have improved the outcome. t(4;14) used to be a high-risk disease. Now by itself today, in this definition by itself is not; it needs to be with something else. And so I think this is a great sign of progress. As we improve the treatment and outcomes, some of the features will become less important, new features will come up, and we'll need to keep on evolving with time and with technology and make it better for patients. Michael Hughes: Thank you so much, Dr. Munshi, for your wisdom, for your sagacity, for your historical perspective as well.  Thank you for listening to JCO Article Insights. Please come back for more interviews and article summaries. And be sure to leave us a rating and review so others can find our show. For more podcasts and episodes from ASCO, please visit asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

Drs. Gurbakhash Kaur and Danai Dima discuss next-gen CAR T and bispecific therapies for myeloma, including agents for extramedullary disease and GPRC5D targets.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/NAW865. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 6, 2026.Expanding the Bispecific Option Across Hematologic Cancers: Guidance for the Community on Collaborative Care and Accessing Innovative Immunotherapy for Myeloma and Lymphoma In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis program is supported by an independent educational grant from Regeneron Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/NAW865. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 6, 2026.Expanding the Bispecific Option Across Hematologic Cancers: Guidance for the Community on Collaborative Care and Accessing Innovative Immunotherapy for Myeloma and Lymphoma In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis program is supported by an independent educational grant from Regeneron Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/NAW865. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 6, 2026.Expanding the Bispecific Option Across Hematologic Cancers: Guidance for the Community on Collaborative Care and Accessing Innovative Immunotherapy for Myeloma and Lymphoma In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis program is supported by an independent educational grant from Regeneron Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.

In this episode of ASTCT Talks, Dr. Rahul Banerjee sits down with Dr. Kenneth Lim and Dr. Yi Lin of Mayo Clinic to discuss a critical and emerging topic in CAR T-cell therapy: delayed neurotoxicities following cilta-cel treatment in multiple myeloma. They break down the clinical features of nerve palsies and Parkinsonism-like symptoms, share diagnostic and treatment strategies and explore emerging predictive markers like absolute lymphocyte count. Given that cilta-cel is increasingly being used in second-line myeloma treatment and is even being studied in first-line treatment to replace stem cell transplantation, this conversation is a timely and insightful look at improving patient outcomes in CAR T-cell therapy.

In this episode, we dissect the phase 3 MIDAS trial in newly diagnosed transplant-eligible multiple myeloma with Dr. Meera Mohan. https://pubmed.ncbi.nlm.nih.gov/39841461/https://pubmed.ncbi.nlm.nih.gov/40459097/

Saad Usmani, MD, MBA leads an in-depth discussion with a panel of leading myeloma experts; Dr. Caitlin Costello, Dr. Binod Dhakal, Dr. Pete Voorhees, and Dr. Shambavi Richard on the evolving landscape of frontline multiple myeloma treatment. The conversation covers the rationale behind quadruplet therapy, the integration of minimal residual disease as a response-adaptive strategy, and shifting perspectives on transplant eligibility and timing. Drawing on recent clinical trial data and personal clinical experience, the panel explores how these advancements are influencing treatment decisions and improving long-term outcomes for patients with newly diagnosed myeloma.

When Ray Hartjen was diagnosed with multiple myeloma - cancer, it was the first thing he thought about when he woke up, and pretty much the last thing he thought about before he nodded off to sleep. It occupied his thoughts most of the day. “I've got cancer!”     After his diagnosis in 2019, Ray became a cancer fighter every day of the week that ends in a 'y'. Along with the soundtrack of life continuously playing in his head, Ray also performs and records with his two-piece acoustic band, the Chronic Padres. To snap out of the trauma, he asked himself what type of role model he wanted to be for his family, friends, and community. What would be his legacy? Ray Hartjen is a writer and musician whose professional career has spanned parts of five decades. Ray has pivoted on many occasions, from investment banking to pharmaceuticals, from consumer electronics to software. One constant throughout his career path has been storytelling with topics as far-ranging as sports to business.   Me, Myself & My Multiple Myeloma is a cancer-patient memoir written by Ray Hartjen, a multiple myeloma patient diagnosed in March 2019. In this intimate and inspiring account, Ray reflects on every step of his relentless battle with cancer, from working toward a final diagnosis, through an initial induction treatment and an autologous stem cell transplant, and on to maintenance and continuing active treatment. Through it all, Ray shares personal insights into his fight, tending to his systemic physical, mental, emotional, and spiritual needs. Fighting cancer or any serious health issue, particularly a chronic condition, can be a daunting quest. Me, Myself & My Multiple Myeloma shows the importance of being mission-forward. Mission, of course, is unique to each individual and based on values, roles, and the accountabilities associated with each that matter most. Written for cancer patients, their caregivers, and their friends and family, Me, Myself & My Multiple Myeloma is a personal story of proactive accountability, stubborn perseverance, evolving perceptions, growing maturity, and, ultimately, hope

Philippa Charles, Director of the DFN Charitable Foundation, leads a conversation on the Foundation's strategic philanthropic approach and its distinctive commitment to long-term, systems-level impact. With a background in leading one of the UK's major family foundations and now at the helm of DFN, she offers a compelling look at how deeply personal motivations can shape focused and effective grantmaking. The DFN Foundation operates across four thematic pillars: disability education, disability employment, myeloma cancer research, and conservation. These areas are not only strategic but are also rooted in the lived experiences and values of the Foundation's founding family. This grounding translates into a uniquely empathetic and effective model of philanthropy—one that combines substantial funding with strategic oversight and deep engagement with delivery partners. The episode explores how DFN supports systemic change in disability inclusion. Philippa discusses the success of Undershaw, a school for students with special educational needs that recently received an “Outstanding” rating from Ofsted, and the DFN Project SEARCH initiative, which has helped more than 3,000 young people with disabilities secure meaningful employment across over 200 corporate and public sector partners. These stories illustrate DFN's commitment not just to education and training but to shifting the broader landscape of opportunity for disabled individuals. A similarly strategic approach underpins the Foundation's investment in myeloma research. Through the Jacquelin Forbes Nixon Fellowship, DFN has supported a clinical trial at the Institute of Cancer Research that is producing transformative outcomes. Over 75% of participants remain in remission—a significant improvement over standard care—and the research now points toward wider clinical application and deeper exploration into treatment efficacy and patient outcomes. DFN's work extends beyond the UK, particularly in conservation. In Kenya, the Foundation supports the Pangolin Project, an initiative preserving 5,000 hectares of biodiverse forest and protecting the world's most trafficked and critically endangered mammal. The project embodies the Foundation's ability to balance localized impact with global relevance, and its philosophy of acting where there is both clear need and the opportunity for catalytic intervention. Throughout the discussion, Philippa reflects on the leadership demands of running a multifaceted family foundation. She shares how she is structuring her first year in the role by focusing on governance, partnerships, operational strategy, and long-term vision. Her insights offer a valuable roadmap for those leading or advising mission-driven organizations, especially those navigating the complexities of family philanthropy. The conversation concludes with a discussion of collaboration across the sector and the importance of peer networks among foundations. Philippa also speaks passionately about the transformative power of volunteering, not only as a form of civic engagement but as a professional and personal development tool. For those interested in strategic philanthropy, disability inclusion, evidence-based research funding, and conservation efforts with measurable impact, this episode provides a thoughtful and informative exploration of how one foundation is driving change across sectors—anchored in personal values, executed with professional discipline, and amplified through strategic partnerships. Thank you for downloading this episode of the Do One Better Podcast. Visit our Knowledge Hub at Lidji.org for information on 300 case studies and interviews with remarkable leaders in philanthropy, sustainability and social entrepreneurship.