Myeloma Updates: High-Risk Smoldering, MRD, IVIG, and Maintenance | Natalie Callander, MD | #ASH24

Hi, I'm Natalie Callender from the University of Wisconsin. And some of the things that I think were highlights so far in the meeting that we've heard about, probably a big one is called the Aquila study that is looking at the use of daratumumab versus active observation in patients with smoldering myeloma. This study actually accrued a number of years ago, but finally had a readout that we heard about actually just minutes ago. But in essence, what it told us is that certainly I think for people who meet a definition of high-risk smoldering myeloma, active observation really is no longer the standard of care. And I think this is going to be probably the last major trial that allows for an active observation arm. Now, one thing that they did show once again is lower risk smoldering myeloma really didn't benefit from intervention. They're actually doing pretty well just on active observation. So I think that's going to remain the same. A couple of the other things that we're interested in, there's a lot of discussion about maintenance and whether it should remain lenalidomide. That's really been the standard since 2009 when the original studies were presented with lenalidomide maintenance. We heard a little bit about the European Myeloma Network, EMN30, also known as Majestic Fork, excuse me. And what this study is looking at is the use of a, really for the first time in a large So what they presented today, which was very interesting, is safety data as well as efficacy data. And ended up showing that in particular either the combo of toclistomab and lenalidomide, and the toclistomab is actually given for a period of about a year, or toclistomab by itself. They both performed very well in terms of moving somebody from MRD to a drug that's been used for a long time. And so they ended up showing that the combination of the two, the two, the two, the two, the the two improved the accuracy from MRD positive to negative as assessed at a year, and they also improved the complete response rate. So I think we're going to see more efforts like that to use perhaps a more intensive maintenance for shorter periods of time, and hope to improve responses. I think some of the other information that came out that's been very important is there was an interesting retrospective analysis looking at intravenous gamma globulin use. And this is something that a lot of experts have recommended for people with myeloma, particularly those getting cellular therapies or people who have an IV or have an IgG level lower than 400 milligrams per deciliter. And what they were able to show in this study is that in particular people receiving a cellular therapy, if they got prophylactic intravenous gamma globulin or just gamma globulin, it could be subcutaneous as well, given before there was any risk of infection that they did better than those who got intravenous gamma globulin started at the time of infection or those who had none at all. And so I think that's very important. It kind of sustains a practice that we've already seen. A couple of the other things that I think are interesting is that we still know that people who have what we call maybe double hit myeloma or those who have more than two or more high risk cited genetic features, there's a number of studies that unfortunately are showing that even with our best quadruplet regimens for induction, that group of patients is still needing something in addition. That ends up being somewhere around 10 to 15% of individuals. And that's also true for a group of patients that we would call functional high risk. These are individuals who have some sort of initial therapy, but within 12 to 18 months afterwards are requiring some additional therapy. So I think that is something, that's a message I think we're continuing to hear with all of these studies. And maybe we'll see your answers below as well. And if you're good, please do do let me know. Make sure that you submit your positions and understand is basically interventions population, what it looks like in a quick way. And I will see you in two or three weeks. New with The Lift. And if you have more information, you can always click me up in the chat box at the top and I'll reply as soon as he does what he tells me to do. Thank you.