Andrzej Jakubowiak, MD, PhD University of Chicago Interview Date: October 19, 2016 

Newly diagnosed multiple myeloma is the most sensitive to treatment, so picking the best up-front treatment is key to getting long-term optimal outcomes. Dr. Andrzej Jakubowiak, MD, PhD shares his experience for newly diagnosed patients. He highly suggests triple combinations before stem cell transplants vs. doublet combinations. He is impressed with the Kyprolis, Revlimid, dex triple combination, especially for patients without heart conditions. He also likes the Velcade, Revlimid, dex triple combination for patients without peripheral neuropathy. With more significant disease reduction and patient responses, Dr. Jakubowiak shares that we can now use more sensitive testing (minimal residual disease testing) to help identify which treatments are and are not working at earlier phases of clinical trials. He also suggests that they may become end points worth measuring during these studies. He notes that patients with minimal disease negativity do typically have longer lasting outcomes, but patients with some minimal residual disease can still have good outcomes. To further test the impact of MRD status, he is running a unique trial post transplant that compares Revlimid alone to Ixazomib, Revlimid and dexamethasone (an all oral combination). He stresses that good risk patients benefit from more aggressive myeloma treatment up front and says that this theme is moving its way into the clinic for high-risk smoldering myeloma patients. Dr. Jakubowiak shares a variety of strategies that can be used at relapse, depending on the kind of relapse and options previously used.

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