Dr. Madduri on Challenges in Transplant-Eligible Patients With Myeloma

Deepu Madduri, MD, assistant professor, medicine, hematology and medical oncology, Mount Sinai Hospital, discusses challenges in the transplant-eligible myeloma population.

One of the main challenges with transplant is getting the referrals to the institutions where they perform the procedure, says Madduri. As such, many patients who come from the community have been on lenalidomide (Revlimid) for longer than 4 to 6 cycles. Ideally, the best time to harvest a patient’s cells is within 4 to 6 cycles of lenalidomide therapy, explains Madduri. Being on lenalidomide beyond that can decrease the stem cell harvest. To avoid this, patients must be assessed when they come to the clinic in order to determine whether they are candidates for transplant.

C. Ola Landgren, MD, PhD, of Memorial Sloan Kettering Cancer Center, published a paper showing that patients who have received 4 to 6 cycles of induction get a bone marrow biopsy.

If patients test negative for minimal residual disease (MRD), they continue their current induction therapy as part of consolidation. If they’re MRD-positive, they undergo transplant and are then put on maintenance, concludes Madduri.