Dr Koehne on ​the Evolution of the Multiple Myeloma Treatment Paradigm

"What we [see] more and more is that targeted approaches for the management of multiple myeloma are enhancing and developing really fast."

Guenther Koehne, MD, deputy director and chief of Stem Cell Transplantation, Hematologic Oncology and Benign Hematology at Miami Cancer Institute, Baptist Health South Florida, discusses updates in multiple myeloma management that were discussed at the Sixth Annual Miami Cancer Institute Global Summit on Immunotherapies for Hematologic Malignancies.

The treatment paradigm for multiple myeloma is rapidly evolving, with the development of more targeted regimens continuing at an unprecedented pace, Koehne begins. At the meeting, Koehne and colleagues discussed whether novel therapies should be administered as monotherapies or as part of combination regimens. Koehne notes that ongoing clinical trials are poised to provide further insights into optimizing patient outcomes with these agents.

One area of debate is the role of autologous stem cell transplantation (ASCT) in the era of CAR T-cell therapy and bispecific antibodies, Koehne says, referencing research presented by Paul G. Richardson, MD, of Dana-Farber Cancer Institute, at the meeting. This presentation highlighted the relative benefits and risks associated with ASCT and focused on the use of melphalan as part of the transplantation process. Melphalan is associated with relatively mild early-stage toxicity compared with CAR T-cell therapies, which can cause significant and potentially underestimated AEs, Koehne states. However, this agent carries the long-term risk of inducing secondary leukemia or myelodysplastic syndromes, he cautions. This risk necessitates a careful evaluation of each patient’s need for ASCT, particularly when considering post-transplant maintenance with lenalidomide (Revlimid), he explains.

Although this debate remains unresolved, it has prompted further consideration of the role of ASCT in the treatment paradigm as newer therapies become available, according to Koehne. Despite emerging treatment alternatives, ASCT remains a key component of the standard of care, he emphasizes. Its safety profile is favorable, with a morbidity rate of approximately 1%, making it a viable treatment option for many patients, he reports. Additionally, cost-effectiveness is a crucial factor in therapeutic decision-making, he says. Compared with CAR T-cell therapies and bispecific antibodies, ASCT is significantly less expensive, further supporting its continued consideration in treatment strategies for patients with multiple myeloma, Koehne concludes.