Multiple myeloma

Multiple Myeloma

Multiple Myeloma Part 1

What were the results of the CASTOR trial in r/r MM ?

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Dara-Rd is superior to Rd wrt PFS in r/r MM

Multiple Myeloma Part 1
multiple myeloma

What did the POLLUX trial assess in MM ?

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Dara-Rd vs Rd in r/r MM with more 1 or more lines of therapy

multiple myeloma
multiple myeloma

What were the results of the FOCUS trial in MM ?

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Single agent carfilzomib has similar efficacy to that of Cyclophosphamide/dex

multiple myeloma
multiple myeloma

Does doxo¬¬¬¬rubicin improve bortezomib responses in heavily pretreated r/r MM ?

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Yes, MMY-3001 trial

multiple myeloma
multiple myeloma

What were the results of the PANORAMA 1 trial in MM ?

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Bortezomib, Dexamethasone, Panobinostat has superior PFS vs Bortezomib, Dexamethasone

multiple myeloma
multiple myeloma

What did the PANORAMA 1 trial assess in MM ?

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Bortezomib, Dexamethasone, Panobinostat versus Bortezomib, Dexamethasone in r/r MM

multiple myeloma
multiple myeloma

What was the dosing and administration of bortezomib in the APEX trial ?

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1.3mg/m2 D1,4 and 8,11 on a 21 day cycle , given as IV bolus

multiple myeloma
multiple myeloma

What did the APEX trial assess in r/r MM ?

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Bortezomib versus dex in r/r MM after 1-3 lines of prior therapy

multiple myeloma
multiple myeloma

What did the SIRIUS trial assess in r/r MM ?

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Daratumumab monotherapy in heavily pretreated MM

multiple myeloma
multiple myeloma

Is there phase 3 data to support the use of bendamustine in r/r MM ?

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No, only phase 2 data

multiple myeloma
multiple myeloma

What did the FOCUS trial assess in r/r MM ?

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randomized phase III study of carfilzomib vs low-dose corticosteroids with optional cyclophosphamide in relapsed and refractory multiple myeloma

multiple myeloma
multiple myeloma

What did the REPEAT trial assess in MM ?

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Phase 1/2 trial of cyclophosphamide, lenalidomide, and prednisone in r/r MM

multiple myeloma
Multiple Myeloma Part 1

How is elotuzumab approved?

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Second line in combination with lenalidamide and dexamethasone

Multiple Myeloma Part 1
Multiple myeloma

What is the protein target of elotuzumab?

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SLAMF7

Multiple myeloma
Multiple myeloma

What 2 humoral immune system cells does Elotuzumab target?

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Plasma cells and natural killer cells

Multiple myeloma
Multiple myeloma

What advantage is there with dexamethasone 40 mg daily versus 40 mg day 1, 2, 3, 4?

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Lower toxicity and lower mortality with the lower frequency dosing

Multiple myeloma
Multiple myeloma

What are the most common adverse event seen with Rd?

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Neutropenia of 30-40%, deep venous thrombosis 11%

Multiple myeloma
Multiple myeloma

What long-term side effects can be seen with IMID use?

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Secondary cancers

Multiple myeloma
Multiple myeloma

What is the absolute incidence of deep venous thrombosis in patients with Rd vs d?

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11% versus 4%

Multiple myeloma
Multiple myeloma

How is thalidomide excreted?

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Kidney

Multiple myeloma
Multiple myeloma

What is the overall response rate of thalidomide + dexamethasone in patients who fail VRd?

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25%

Multiple myeloma
Multiple myeloma

What is the most common adverse event seen with pomalidmide+ dexamethasone?

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Neutropenia

Multiple myeloma
Multiple myeloma

Which patients should not be treated with immunomodulatory agents?

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Pregnant patients

Multiple myeloma
Multiple myeloma

Which of the immunomodulatory agents is least used in multiple myeloma treatment?

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Thalidomide because of side effect profile and response rates

Multiple myeloma
Multiple myeloma

What is a significant drawback of thalidomide use?

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Peripheral neuropathy

Multiple myeloma
Multiple Myeloma Part 2

Which FISH probes are required for multiple myeloma workup?

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T(4;14), t(6;14), t(11;14), t(14;16), t(14;20)

Multiple Myeloma Part 2
Multiple myeloma

What prophylaxis is required with bortezomib ?

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Acyclovir with or without Bactrim

Multiple myeloma
Multiple myeloma

How can you get a very rapid initial response for patients with cast nephropathy myeloma?

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Bortezomib 2 times weekly for 1 cycle plus Dexamethasone 40 mg daily days 1-4, 8 of 11, 14-17

Multiple myeloma
Multiple myeloma

How can you manage intermediate and high-risk multiple myeloma patient status post autologous stem
cell transplant?

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bortezomib maintenance every 2 weeks

Multiple myeloma
Multiple myeloma

What risk strata patients can be offered a delayed autologous stem cell transplant ?

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Standard risk
Intermediate and high risk should not

Multiple myeloma
Multiple myeloma

When would you consider CyBorD rather than VRd for induction for myeloma?

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Countries with limited resources and in patients with high thrombosis risk

Multiple myeloma
Multiple myeloma

Which immunomodulatory agent is preferred in the induction setting for multiple myeloma?

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Revlimid

Multiple myeloma
Multiple myeloma

When would Revlimid and dexamethasone be used for induction in multiple myeloma?

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Frail elderly patients

Multiple myeloma
Multiple myeloma

What are the major side effects with thalidomide?

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Neuropathy , edema and DVT

Multiple myeloma
Multiple myeloma

What is the most common side effect with CyBorD ?

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Neutropenia, seen in 25% therefore prophylaxis required

Multiple myeloma
Multiple myeloma

When would CyBorD be an acceptable induction regimen for multiple myeloma?

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If RVd is not available

Multiple myeloma
Multiple myeloma

What is the VRd induction dose for multiple myeloma?

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Bortezomib 1.3 mg/m2 day 1, 7, 14
Revlimid 25 mg per day day 1-14, 7 days off
Dexamethasone 40 mg daily 1, 7, 14
All on a 21 day cycle

Multiple myeloma
Multiple myeloma

What are 3 considerations when deciding to use lenalidomide in multiple myeloma ?

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Poor stem cell collection yields, dose adjustments in renal failure , necessity for DVT
prophylaxis

Multiple myeloma
Multiple myeloma

What 2 supportive care measures are required alongside induction regimen for multiple myeloma?

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DVT prophylaxis and bisphosphonates

Multiple myeloma
Multiple myeloma

What are 2 equivalent approaches to multiple myeloma induction with stem cell transplant?

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2-4 cycles of induction then autologous stem-cell transplant
Induction for 12-18 months then autologous stem cell transplant at relapse

Multiple myeloma
Multiple myeloma

What is a significant long-term side effect with Elotuzumab?

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Increase in secondary malignancies

Multiple myeloma
Multiple myeloma

What blood complete blood count changes are notable with elotuzumab?

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Lymphopenia

Multiple myeloma
Multiple myeloma

What are the challenges with treatment monitoring with daratumumab and elotuzumab?

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They interfere with serum protein electrophoresis

Multiple myeloma
Multiple myeloma

What are 3 major side effects with panobinostat?

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Diarrhea, coronary artery disease, arrhythmia

Multiple myeloma
Multiple myeloma

How is panobinostat approved?

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Third line agent

Multiple myeloma
Multiple myeloma

What is the mechanism of action of panobinostat?

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HiDAC inhibitor

Multiple myeloma
Multiple myeloma

How can you manage moderate and severe diarrhea from panobinostat?

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Hold the medication

Multiple myeloma
Multiple myeloma

Which chemotherapy agents are active in multiple myeloma?

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Vincristine, doxorubicin, melphalan, cyclophosphamide, bendamustine

Multiple myeloma
Multiple myeloma

What is the VAD regimen?

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Vincristine, Adriamycin, dexamethasone

Multiple myeloma
Multiple myeloma

Ideally how long should the interval be between relapsed disease and last treatment prior to attempting
a re-challenge?

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12 months

Multiple myeloma
Multiple myeloma

For good risk patients who have not undergone stem cell transplant, what is recommended on relapse
or progression on therapy?

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Proceeding with transplant

Multiple myeloma
Multiple myeloma

What is another definition of high-risk disease besides the primary risk strata for multiple myeloma?

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Relapse within 12 months from first line therapy or progression on current therapy

Multiple myeloma
Multiple myeloma

What defines progressive disease in multiple myeloma?

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25% increase from the lowest response value for the M-protein in the serum, M-protein in the urine,
bone marrow biopsy plasma cell increased by 10%, change in the light chain ratio for an absolute
increased by greater than 10 mg/dL, new bone lesions, increase in size of bone lesions, calcium
elevation to greater than 11.5

Multiple myeloma
Multiple myeloma

How is bortezomib metabolized?

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Hepatic

Multiple myeloma
Multiple myeloma

How can you adjust lenalidamide with various neuropathy gradings?

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Grade 1– no pain or interference with activities of daily living continue with a 1.3 mg/m2
Grade 2 – pain but no interference with activities of daily living 1 mg/m2
Grade 3 – interference of activities of daily living 0.7 mg/m2

Multiple myeloma
Multiple myeloma

Which bortezomib patients should get acyclovir or valacyclovir?

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All of them

Multiple myeloma
Multiple myeloma

What is a very rare central nervous system side effect of bortezomib ?

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Reversible posterior leukoencephalopathy syndrome

Multiple myeloma
Multiple myeloma

What is the FDA indication for carfilzomib ?

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Progression on at immunomodulatory agent and proteasome inhibitor

Multiple myeloma
Multiple myeloma

How do you dose adjust bortezomib for liver dysfunction?

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Start it at 0.7 mg/m2

Multiple myeloma
Multiple myeloma

What is the most common side effect with ixazomib ?

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Diarrhea

Multiple myeloma
Multiple myeloma

What differentiates ixazomib from other protease inhibitors?

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It can be taken orally

Multiple myeloma
Multiple myeloma

What prophylaxis is required with Daratumumab in multiple myeloma ?

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Acyclovir

Multiple myeloma
Multiple myeloma

How can you manage infusion reactions with daratumumab?

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Discontinuing Steroids to avoid a delayed infusion reaction

Multiple myeloma
Multiple myeloma

What laboratory studies does daratumumab interfere with?

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Coomb’s

Multiple myeloma
Multiple myeloma

What type of antibody is daratumumab?

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IgG kappa

Multiple myeloma
Multiple Myeloma Part 3

How do you distinguish a solitary plasmacytoma from multiple myeloma?

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Bone marrow biopsy with a normal electrophoresis versus at least 10% marrow involvement with
plasma cells

Multiple Myeloma Part 3
Multiple myeloma

How can you distinguish IgM multiple myeloma from Waldenstroms?

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T(11;14) translocation, would not be seen in Waldenstrom’s, as well as CD20 positivity

Multiple myeloma
Multiple myeloma

Which diagnosis should be suspected in multiple myeloma patients with new onset heart failure, low
albumin and nephrotic syndrome ?

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Light chain amyloidosis

Multiple myeloma
Multiple myeloma

Which serum markers are important for POEMS syndrome?

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VEGF

Multiple myeloma
Multiple myeloma

What work-up is necessary if imaging shows suspicious lytic bone lesions, low M-protein and a bone marrow
biopsy of less than 10% plasma cells but a high clinical suspicion of multiple myeloma ?

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Recommend biopsy of a bone lesion

Multiple myeloma
Multiple myeloma

What is the negative predictive value of a bone marrow biopsy for multiple myeloma?

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Low, therefore if a negative bone marrow biopsy, repeat from a different site

Multiple myeloma
Multiple myeloma

How can you monitor non-secretory myeloma?

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Bone marrow biopsy and imaging

Multiple myeloma
Multiple myeloma

What 4 studies can increase the sensitivity of multiple myeloma diagnosis to 97%?

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Immunofixation for the serum as well for the 24-hour urine

Multiple myeloma
Multiple myeloma

Which light chain is the most common in myeloma?

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Kappa

Multiple myeloma
Multiple myeloma

What percentage of multiple myeloma has no detectable light chain or M-protein?

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6.5%

Multiple myeloma
Multiple myeloma

Which immunoglobulin is most common in multiple myeloma?

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IgG, 50%
IgA 20%
Light chain disease 16%

Multiple myeloma
Multiple myeloma

What diagnosis should be considered if neuropathy is present in the context of an elevated M-protein?

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POEMS syndrome

Multiple myeloma
Multiple myeloma

What is the most common symptomatic or laboratory abnormality for newly diagnosed multiple
myeloma?

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Anemia

Multiple myeloma
Multiple myeloma

How long is induction therapy for multiple myeloma prior to autologous stem cell transplant?

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2-4 months

Multiple myeloma
Multiple myeloma

What are the induction regimens for intermediate and standard risk versus high-risk multiple myeloma?

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High risk preferred KRD versus VRD for the other 2

Multiple myeloma
Multiple myeloma

What are the 3 intermediate risk factors for multiple myeloma?

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T(4;14) translocation, 1q+, chromosome 13 deletion, hypodiploid

Multiple myeloma
Multiple myeloma

What are the high-risk features of multiple myeloma?

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17p deletion, t(14;16), t(14;20), LDH greater than 2 times upper limit or normal, plasma cell leukemia,
high risk gene expression profile signature

Multiple myeloma
Multiple myeloma

What are 3 indications for starting treatment for multiple myeloma with respect to bone involvement ?

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Osteopenia, greater than equal to 2 plasmacytoma lesions, lytic lesions

Multiple myeloma
Multiple myeloma

What is the major problem with bone marrow biopsies as a diagnostic study for multiple myeloma?

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Involvement could be patchy–focal , hence need for a re-biopsy is common

Multiple myeloma
Multiple myeloma

What is the typical flow cytometry signature for multiple myeloma?

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CD 38 positive, 138 positive, 19-negative, 56-negative, 45-negative with light chain restriction

Multiple myeloma
Multiple myeloma

What is the normal light chain ratio in healthy patients?

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0.26-1.65

Multiple myeloma
Multiple myeloma

Where are most of the myeloma lytic bone lesions?

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They are near very active bone marrow such as vertebral, skull, proximal, humerus and femur

Multiple myeloma
Multiple myeloma

How do you evaluate bone pain in a myeloma patient with a negative bone survey?

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MRI

Multiple myeloma
Multiple myeloma

Which imaging study should be avoided in myeloma patients with a GFR less than 30?

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Gadolinium because of fibrosis risk

Multiple myeloma
Multiple myeloma

What type of metastases are multiple myeloma bone lesions ?

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Osteolytic

Multiple myeloma
Multiple myeloma

Which 2 labs besides a complete blood count, electrophoresis and complete metabolic panel are
required for staging multiple myeloma?

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LDH and beta-2 microglobulin

Multiple myeloma
Multiple myeloma

What are the non-CRAB criteria for multiple myeloma diagnosis?

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Plasma cells greater than or equal to 60%, light chain ratio greater than 100, MRI showing more than 1
lesion

Multiple myeloma
Multiple myeloma

What defines high-risk disease for MM patients with good risk and standard risk cytogenetic profile ?

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Progression within 12 months of therapy

Multiple myeloma
Multiple myeloma

What defines progressive disease for multiple myeloma?

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Increase in M-protein greater than 0.5 g/dL or greater than 200 mg in a 24-hour period for the urine
Increased bone marrow percentage of plasma cells, greater than 10%
Change in the light chain ratio or an absolute increase by 10 mg/dL

Multiple myeloma
Multiple myeloma

What are the 3 different ISS stage criteria for multiple myeloma?

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Stage I albumin greater than or equal to 3.5 and Beta-2 mcg less than 3.5
Stage II everything in between
Stage III beta-2 mcg greater than or equal to 5.5

Multiple myeloma
Multiple myeloma

What is the difference in progression free survival for intermediate and standard risk myeloma versus
poor risk status post autologous stem cell transplant ?

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24 months versus 12 months

Multiple myeloma
Multiple myeloma

What is the prognostic significance of a complete response, very good partial response, and partial response in multiple myeloma ?

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No relation to prognosis

Multiple myeloma
Multiple myeloma

What defines a complete response and stringent complete response for multiple myeloma?

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Complete response negative immunofixation in the serum and urine, no plasmacytoma, less than 5%
plasma cells in the bone marrow
Stringent complete response is a complete response pulses normal light chain ratio plus a bone marrow
biopsy light chain ratio 4:1

Multiple myeloma
Multiple myeloma

For non-autologous stem cell transplant candidate patients with multiple myeloma, how long is
induction?

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Rd until progression
VRD for 12-18 months or until M-protein plateau

Multiple myeloma
Multiple myeloma

Which patients can be considered for a tandem transplant?

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Younger patients, 17p deletion, worse than a very good partial response, no other contraindications that
exclude from a transplant within 6 months

Multiple myeloma
Multiple myeloma

What are common post-transplant maintenance regimens for multiple myeloma?

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Intermediate and high-risk – bortezomib,
poor risk – lenalidomide

Multiple myeloma
Multiple myeloma

What defines a very good partial response for multiple myeloma?

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Greater than 90% M-protein reduction, urine M-protein less than 100 mg in 24 hours, urine and serum
M-protein only detectable by immunofixation

Multiple myeloma
Multiple myeloma

What are common exclusion criteria for autologous stem cell transplant in multiple myeloma?

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Age greater than 77, bilirubin greater than 2.0, ECOG 3 or 4 , New York Heart Association stage
III or stage IV heart failure

Multiple myeloma
Multiple myeloma

What risk is a trisomy cytogenetics signature for multiple myeloma?

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Standard risk

Multiple myeloma
Multiple myeloma

What is the treatment algorithm for newly diagnosed high risk and intermediate risk multiple myeloma?

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High risk KRD for 4 cycles then stem cell transplant
Intermediate risk VRD for 4 cycles and stem cell transplant

Multiple myeloma
Multiple Myeloma Part 4

What did the EQUULEUS trial assess in MM ?

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Dara-PD in r/r MM

Multiple Myeloma Part 4
multiple myeloma

Which IMiD is used in DTPACE ?

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Thalidomide

multiple myeloma
multiple myeloma

Has bortezomib-HyperCVAD been evaluated against modified HyperCVAD for r/r MM ?

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Only in a retrospective review, no prospective phase 3 trial

multiple myeloma
multiple myeloma

What did the STORM trial assess in MM ?

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Selinexor + dexamethasone in heavily pretreated MM refractory to bortezomib, carfilzomib, lenalidomide, and pomalidomide

multiple myeloma
multiple myeloma

Is there data to support the use of Auto-HSCT in relapsed MM ?

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Yes, NCRI Myeloma X Relapse trial

multiple myeloma
multiple myeloma

Did the CASTOR trial have as the maintenance phase for r/r MM ?

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Yes, Daratumumab/dex, while bortezomib was stopped after 8 cycles

multiple myeloma
multiple myeloma

What was the most common grade 3/4 AE in the CASTOR trial for r/r MM ?

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Thrombocytopenia

multiple myeloma
multiple myeloma

Were most patients heavily pretreated in CASTOR ?

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No, ~50% only 1 prior line of therapy

multiple myeloma
multiple myeloma

What was the purpose of the CASTOR trial in r/r MM ?

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Test the efficacy of Daratumumab, Bortezomib, and Dexamethasone versus Bor/Dex in r/r MM

multiple myeloma
multiple myeloma

Is there randomized phase 3 data to support the use of any maintenance regimen following second line therapy in MM ?

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No, only phase 2 data from a few trial

multiple myeloma
multiple myeloma

What is the PAD/VCD regimen used in plasma cell leukemia ?

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Alternating bortezimib/doxorubicin/dexamethasone and bortezimib/cyclophosphamide/dexamethasone

multiple myeloma
multiple myeloma

Which phase 3 trial has shown the superiority of any particular regimen in plasma cell leukemia ?

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None

multiple myeloma
multiple myeloma

Which myeloma agents have shown activity in POEMS ?

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lenalidomide plus dexamethasone in a phase 2 trial, 60% PFS at 3 years

multiple myeloma
Multiple Myeloma

What did the COLUMBIA trial assess for daratumumab in multiple myeloma ?

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Non-inferiority of Subcutaneous versus intravenous therapy daratumumab in progressive MM

Multiple Myeloma
Multiple Myeloma

Which cytotoxic agents retain efficacy in penta-refractory MM patients ?

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Bendamustine, cyclophosphamide, etoposide and cisplatin

Multiple Myeloma
Multiple Myeloma

Is subcutaneous daratumumab inferior to the infusion with respect to efficacy ?

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No

Multiple Myeloma
Multiple Myeloma

Do standard risk patients have similar survival outcomes versus high risk in CD38 Ab refractory MM ?

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No, better survival outcomes

Multiple Myeloma
Multiple Myeloma

Does high LDH predict for worse survival outcomes in CD38 antibody refractory MM patients ?

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Yes

Multiple Myeloma
Multiple Myeloma

What was the first combination of isatuximab approved as by the FDA?

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pomalidomide and dexamethasone

Multiple Myeloma
Multiple Myeloma

What is the target of isatuximab ?

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CD38

Multiple Myeloma
Multiple Myeloma

Do the addition of carfilzomib or bortezomib increase the ORR of selinexor + dexamethasone ?

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Yes

Multiple Myeloma
Multiple Myeloma

Is there data to support the use of selinexor with carfilzomib and dexamethasone ?

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Yes

Multiple Myeloma
Multiple Myeloma

What is the target of selinexor ?

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XPO1

Multiple Myeloma
Multiple Myeloma

What is the CAR-T target for MM ?

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BCMA

Multiple Myeloma
Multiple Myeloma

What is the most common patient reported side effect with selinexor in MM?

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Nausea

Multiple Myeloma
Multiple Myeloma

Is there data supporting the use of TPO mimetics in the management of thrombocytopenia with selinexor in MM ?

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Yes

Multiple Myeloma
Multiple Myeloma

What is one of the most challenging hematologic side effects with selinexor?

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Grade 4 thrombocytopenia has been reported in more than 25% of patients

Multiple Myeloma
Multiple Myeloma

What is the incidence of sepsis related mortality for Auto-HSCT in MM patients?

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1%

Multiple Myeloma
Multiple myeloma

What are 2 causes of kidney injury in multiple myeloma?

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Light chain cast nephropathy and hypercalcemia

Multiple myeloma
Multiple myeloma

What are the poor risk cytogenetic features for multiple myeloma?

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13q, t(4;14), t14;20), t(14:16), 1q amplification, 17p deletion

Multiple myeloma
Multiple myeloma

How many months of lenalidomide-free interval are needed prior to being re-challenged?

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6 months

Multiple myeloma
Multiple myeloma

What are the diagnostic criteria for POEMS ?

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2 major including polyneuropathy, demyelinating neuropathy, M-spike

Plus 1/3 major: Castleman syndrome, sclerotic bone, high levels of soluble VEGF

Plus 1/6 minor: organomegaly, volume overload, endocrinopathy, skin changes, papilledema, elevated
platelets, elevated hemoglobin

Multiple myeloma
Multiple myeloma

How many centigray of radiotherapy is used for solitary plasmacytoma?

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4500 cGy

Multiple myeloma
Multiple myeloma

What regimen is appropriate for elderly / frail patients with multiple myeloma?

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lenalidamide dexamethasone

Multiple myeloma
Multiple myeloma

What is the post-autologous stem cell transplant lenalidamide dose for maintenance?

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10 mg per day

Multiple myeloma
Multiple myeloma

What is the creatinine clearance cut-off for using zoledronic acid in multiple myeloma?

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30

Multiple myeloma
Multiple myeloma

What is the peripheral blood threshold for defining plasma cell leukemia?

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20%

Multiple myeloma
Multiple myeloma

What are the risk factors for deep venous thrombosis prophylaxis for multiple myeloma?

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BMI greater than 30, prior history of venous or arterial thromboembolism, underlying stroke history,
major comorbidities including diabetes coronary artery disease chronic kidney disease paralysis prior
surgery, concurrent EPO use, history of clotting disorder, if 0 or 1 risk factors then use baby aspirin
If 2 or more risk factor then low molecular weight heparin or Coumadin preferred

Multiple myeloma
Multiple myeloma

What causes a false positive reading on MRI in the early phase of multiple myeloma treatment?

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Sclerosis

Multiple myeloma
Multiple myeloma

What defines smoldering myeloma?

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M-protein greater than 3 g and/or bone marrow biopsy with between 10-60% plasma cell involvement
with no end organ damage, lambda ratio greater than 100 and no evidence of amyloidosis

Multiple myeloma
Multiple Myeloma Part 5

What were the results of the phase 3 CASSIOPEIA trial ?

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Dara-VTP has superior PFS vs VTP

Multiple Myeloma Part 5
Multiple Myeloma

What was the CASSIOPEIA trial ?

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Dara-VTP vs VTP in newly diagnosed MM, phase 3

Multiple Myeloma
Multiple Myeloma

What were the results of the phase 3 ALCYONE trial ?

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Dara-VMP has superior PFS vs VMP

Multiple Myeloma
Multiple Myeloma

What was the ALCYONE trial ?

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Dara-VMP vs VMP in newly diagnosed MM, phase 3

Multiple Myeloma
Multiple Myeloma

What did the MAIA trial assess ?

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Dara-Rd vs Rd in newly diagnosed MM

Multiple Myeloma
Multiple Myeloma

Is there randomized data to support the use of bendamustine in first-line induction for MM ?

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No, only retrospective

Multiple Myeloma
Multiple Myeloma

What were the results of the IFM 2009 trial for MM ?

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Superior PFS but no change in OS

Multiple Myeloma
Multiple Myeloma

What was the structure of the IFM 2009 trial for MM ?

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Phase 3 trial of RVd x 3 cycles then either RVd for 5 more or melphalan + auto-HSCT, both with Rev maintenance x 1 year

Multiple Myeloma
Multiple Myeloma

What are the challenges of interpreting the GMMG-HD4 / HOVON-65 trial now ?

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Induction regimen used vincristine or bortezomib plus doxorubicin/ dexamethasone is not commonly used

Multiple Myeloma
Multiple Myeloma

What did the GMMG-HD4 / HOVON-65 trial determine for bortezomib maintenance after consolidations in MM ?

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Improved PFS versus thalidomide

Multiple Myeloma
multiple myeloma

What has Rd shown to have superior OS to in a phase 3 randomized trial for MM ?

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Dex monotherapy only

multiple myeloma
multiple myeloma

What were the results of the OPTIMISMM trial in r/r MM ?

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Superior PFS

multiple myeloma
multiple myeloma

What did the OPTIMISMM trial assess in r/r MM ?

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Pom-Vd versus Vd in r/r after 1-3 lines of therapy

multiple myeloma
multiple myeloma

Has an OS been shown for pomalidomide in a phase 3 trial in MM ?

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Yes, NIMBUS trial in r/r MM after 2 prior lines of therapy

multiple myeloma
multiple myeloma

What were the results of the ASPIRE trial in MM ?

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KRd vs Rd has superior PFS

multiple myeloma
multiple myeloma

What did the ASPIRE trial assess in r/r MM ?

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KRd vs Rd

multiple myeloma
multiple myeloma

What was the outcome of the ENDEAVOUR trial in r/r MM ?

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Carfilzomib and dexamethasone has superior OS superior to Vd

multiple myeloma
multiple myeloma

What did the ENDEAVOUR trial assess in MM ?

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Carfilzomib and dexamethasone versus bortezomib and dexamethasone in r/r MM

multiple myeloma
multiple myeloma

Is there phase 3 data to support the use of Kd vs Rd in r/r MM ?

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Yes, the ENDEAVOUR trial

multiple myeloma
multiple myeloma

What was the ICARIA-MM trial in r/r MM ?

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Phase 3 trial of Ixasomib-Pd vs Pd in r/r who had progressed after Rev and a PI

multiple myeloma
multiple myeloma

What was the TOURMALINE-MM1 trial in r/r MM ?

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Phase 3 trial of Ixasomib-Rd vs Rd in r/r MM after Rev and a PI

multiple myeloma
multiple myeloma

What was the outcome of the ELOQUENT-3 trial in MM ?

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Elo-Pd has superior PFS versus Pd after progressing on Rev and a PI

multiple myeloma
multiple myeloma

What did the ELOQUENT-3 trial assess in r/r MM ?

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Elotuzumab – Pd versus Pd after progressing on Rev and a PI

multiple myeloma
multiple myeloma

What did the POLLUX trial assess in MM ?

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Dara-Rd vs Rd in r/r MM with more 1 or more lines of therapy

multiple myeloma
multiple myeloma

What were the results of the FOCUS trial in MM ?

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Single agent carfilzomib has similar efficacy to that of Cyclophosphamide/dex

multiple myeloma
multiple myeloma

Does doxo¬¬¬¬rubicin improve bortezomib responses in heavily pretreated r/r MM ?

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Yes, MMY-3001 trial

multiple myeloma
multiple myeloma

What were the results of the PANORAMA 1 trial in MM ?

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Bortezomib, Dexamethasone, Panobinostat has superior PFS vs Bortezomib, Dexamethasone

multiple myeloma
multiple myeloma

What did the PANORAMA 1 trial assess in MM ?

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Bortezomib, Dexamethasone, Panobinostat versus Bortezomib, Dexamethasone in r/r MM

multiple myeloma
multiple myeloma

What was the dosing and administration of bortezomib in the APEX trial ?

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1.3mg/m2 D1,4 and 8,11 on a 21 day cycle , given as IV bolus

multiple myeloma
multiple myeloma

What did the APEX trial assess in r/r MM ?

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Bortezomib versus dex in r/r MM after 1-3 lines of prior therapy

multiple myeloma
multiple myeloma

What did the SIRIUS trial assess in r/r MM ?

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Daratumumab monotherapy in heavily pretreated MM

multiple myeloma
multiple myeloma

Is there phase 3 data to support the use of bendamustine in r/r MM ?

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No, only phase 2 data

multiple myeloma
multiple myeloma

What did the FOCUS trial assess in r/r MM ?

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randomized phase III study of carfilzomib vs low-dose corticosteroids with optional cyclophosphamide in relapsed and refractory multiple myeloma

multiple myeloma
multiple myeloma
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multiple myeloma
multiple myeloma

What did the REPEAT trial assess in MM ?

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Phase 1/2 trial of cyclophosphamide, lenalidomide, and prednisone in r/r MM

multiple myeloma
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