How is a line of therapy defined?

What is a line of therapy? So the line of treatment is just basically we have the protocol for it to just make sure that everyone just really following the same thing. And what we do is if you have any changes in the treatment regimen that we are giving, either we adding things or subtracting it or changing it to something else, like substituting one medication to another, then it is unplanned. Then we consider that one is a one line of treatment to go to another line. So in myeloma, we usually don't give one treatment or one drug at a time because it's like either induction treatment or treatment for the relapse is a combination of a couple of medications together. So, for example, if you have three medication together and I decide based on any reason that one of them should be changed to something else, then that considered the second line of treatment for the patient. So it doesn't matter what's the reason though. So the reason can be the patient couldn't tolerate it. It's an inadequate response or not response at all, or the patient is progressing or relapsing on that treatment. So then that would be a reason for changing the treatment, but we don't consider reason as the reason to count it or not counting it. And it should be planned. For example, like historically we were doing the tandem transplant for the patient. So we already knew that we're going to do two transplant back to back for those people. So the second transplant wouldn't consider the next line of treatment because it was planned. But if I do the transplant on my patient that is already planned ahead of time, I know that I give the induction treatment, I'm going to go and do the transplant, I'm going to go and maintain a treatment, all of them consider one line. But if like a year later I see my patient is progressing and decide to go for the second transplant, this is unplanned decision, then the second transplant consider the second line of treatment for the patient. I think the lines of therapy, I think lines are getting blurred when we define them upon intended. To make this part easier to understand, here's a graph showing the progression of myeloma over time. When the line goes up, myeloma is growing or the patient is relapsing. When the line goes down, the myeloma is responding to lines of treatment. But generally speaking, it used to be that patients would get initial therapy and then they would be off therapy. And then when they would recur, they would get a second line therapy and that potentially that would be continued usually until progression. And then they would get next line of therapy when that treatment was no longer working. That was generally in an era where we didn't have a lot of medications available. And certainly we didn't have some of the established ways of treating myeloma patients now mainly with maintenance therapy that wasn't as defined in the previous year. So the way we currently think about lines of therapy is really when we're changing their therapy from their initial presentation of disease to the time of relapse. So the first treatment can involve induction therapy with or without a stem cell transplant and usually followed by consolidation and maintenance therapy. That is basically one line of therapy simply because their disease presented and has now been treated and controlled. And when we're thinking about next line of therapy in that particular scenario, it's basically when the first relapse occurs. And at that time, the therapy is modified. Looking at some of those variables we discussed, such as whether it's a biochemical progression or a more aggressive clinical progression. But any time a change of therapy is happening at that moment, that's considered second line therapy. And then subsequently, therefore, anytime there's a change in therapy due to progression is where the lines of therapy become a bit more clear on the back end. But generally speaking, in the beginning, we treat the myeloma as we see fit in that particular person. And however long that first course lasts and doesn't lead to a relapse is considered one line of therapy. To see your lines of therapy, sign up for a free CUREhub account by going to healthtree.org, clicking on the CUREhub tab and then clicking join to your hub. Enter your email and connect your medical records. After that, click on track my disease and then treatments.