Choosing the Best Induction Therapy for Fit Patients With Myeloma | Jonathan Kaufman, MD

Hi, my name is Jonathan Kaufman. I'm a professor at Emory University in Atlanta, Georgia, and I'm here at ASH 2025 in Orlando, Florida. And I'm presenting an education session about what is the best induction therapy for a patient who is fit with newly diagnosed myeloma. So the first thing that I will say about our fit patients is what is the best induction therapy. And I think it's very clear based on multiple phase three randomized trials, as well as real world data in its trials, including Griffin and Perseus and GMMG and MRIs and Cepheus. There's no longer a debate for drug induction therapy with a combination of daratumab, artesomib, or carfilzomib, lenalidomide, and dexamethasone is the current standard of care for the fit newly diagnosed patient. So again, this is, and we've shown this both in randomized clinical trials showing a deeper response by measuring MRD, as well as an improvement in progression-free survival. Speaking of MRD, MRD is our new way of determining the benefit of a therapy. And just to clarify, MRD in my mind isn't something that's magical. It is a way of measuring the deepest response. It's our current technology to measure deepest response. And so we know that we can't have a high fraction of MRD negative patients if we don't have fraction of patients in very good partial response or in complete response. So fundamentally, MRD is response. Now we're starting to ask the question, can we use MRD negativity to make decisions later? And in similar to my presentation from several days ago, where I looked at patients who failed to achieve a VGPR, the MIDAS study looked at the patients who were most likely to fail to achieve MRD negativity. And it was really interesting. It was the same two groups. It was those patients who failed to, who had deletion 17P and those patients who had the 1114 translocation. What was really interesting about the 1114 translocation, and this gets really into what happens later for these patients in consolidation. The fraction of patients with 1114 who achieve MRD later is much, much higher than the percentage of patients who improve with any other subgroup. So it's really important, again, if a patient has 1114 and fails to achieve MRD negativity, to not change the approach, is to continue on treatment because those MRD negativities happen later. And it's very likely associated with good outcomes. And so we can dial in the percentage of patients who achieve MRD negativity by looking at the percentage of patients who have deletion 17P, the percentage of patients who have the translocation 1114, the percentage of patients who have the 414 translocation. So looking at MRD, we say, is context dependent. The other really important thing that MIDAS taught us is that when you use really effective for drug induction therapy, the risk status does not impact the likelihood of achieving MRD negativity. And so my third major principle is that if we're going to address risk status, it has to be addressed not in induction when we have very good induction therapies, but it has to be addressed in consolidation and ongoing maintenance therapy. And finally, there's a future where we're pulling in all these new drugs from the relapse setting. And there's a very impressive small study using a BCMA by specific as part of induction. And in that setting, they had 100% MRD negativity rate. So we now know what the current standard is for induction therapy for the fit patient, and that is for drug therapy. So thank you. If our videos have helped you in any way, and you're able to, please consider making a donation to help us continue this important work. Your gift will go three times as far when we reach $500,000 by the end of the year. Every contribution, big or small, makes a difference, and we're deeply grateful for your support.