Patient Introduction

Hello, my name is Maria and I am 61 years old. Three years ago, I was diagnosed with multiple myeloma, and I have received multiple lines of treatment. My first treatment was a combination of medications called VRd. I had a partial response after my first line of treatment, but since then, I have had a stem cell transplant and been treated with two other regimens, including combinations of different inhibitors and antibodies because there was concern about resistance developing with some of the medications. Over the past few weeks, I have been having more back pain that is interfering with my sleep. This is all so overwhelming and I’m worried about what the back pain might mean; I need to talk about what is next for me.

Question #1

I’m sorry to hear you’re having more pain, Maria. Where are you feeling it? And have you had any fevers or weight loss?

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Question #2

I’m afraid that your back pain is most likely related to the multiple myeloma progressing. Have you felt nauseous or very thirsty at all? How about any feelings of restlessness or confusion?

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Question #3

I do; your recent blood tests unfortunately showed rising free light chain levels, indicating the myeloma is progressing. And your PET/CT scan showed signs that your myeloma has spread outside the bones, specifically into your intestines.

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Question #4

That’s correct. I know it’s difficult to hear, but your cancer appears to be resisting your current treatments – I’d like to discuss our options to switch to another therapy. At this stage, different treatment approaches are often needed.

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Question #5

The good news is we have options. Immunotherapies use your immune system to attack myeloma. One type, bispecific antibodies, target proteins on your myeloma cells. CAR T therapy is another option. Immunotherapies can work when chemotherapy and targeted therapies haven’t.

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Question #6

With CAR T-cell therapy, your white blood cells are collected and reprogrammed to teach them to target myeloma cells, but this can take weeks; and chemotherapy is also given with CAR T. Bispecific antibodies can be used right away.

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Question #7

CRS and ICANS can be triggered by the immune attack on myeloma cells. With CRS, the main symptoms include fever and low blood pressure; sometimes oxygen is needed. We’ll also monitor your alertness to watch for neurologic side effects.

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Question #8

We start low and gradually increase to the full dose. We have steroids and tocilizumab to prevent CRS and ICANS and carefully monitor for side effects throughout treatment. Thankfully, CRS and ICANS usually happen during the first month of treatment.

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Question #9

Bispecifics targeting BCMA include teclistamab and elranatamab, while talquetamab targets GPRC5D. Besides CRS, there can be risk for low blood counts or infection.

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Question #10

Yes; a BCMA bispecific antibody, linvoseltamab is under review for FDA approval and has been recommended for approval in Europe. A combination regimen with belantamab mafadotin, a BCMA antibody linked to chemotherapy, will also likely be approved soon.

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Question #11

Based on your preferences, I would recommend starting with a bispecific targeting BCMA. We can schedule your first treatment right away without the need for chemotherapy to get your body ready for treatment, as we do with CAR-T therapy.

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Question #12

Based on your preferences, I would recommend starting with a bispecific targeting BCMA. We can schedule your first treatment right away without the need for chemotherapy to get your body ready for treatment, as we do with CAR-T therapy.

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This activity is provided by Med Learning Group.
This program is supported by an independent educational grant from Regeneron Pharmaceuticals, Inc.

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