[JPC]

Update to Msmart guidelines - newly diagnosed myeloma

by JPC on Fri Dec 04, 2015 9:01 am

Good morning.

The Msmart guidelines for newly diagnosed myeloma have been updated.

http://nebula.wsimg.com/4249c5fe4882f3bc9682df0076015f51?AccessKeyId=A0994494BBBCBE4A0363&disposition=0&alloworigin=1

The note at the bottom of the slide appears to indicate that the update was in December 2015, which means the last couple of days. Generally, the updates are somewhat significant, reflecting recent advances, though I would not say that the updates are radical.

Firstly, CyBorD (cyclophosphamide, Velcade, dexamethasone) is gone from Msmart, in favor of RVD (Revlimid, Velcade, dexamethasone). This is very interesting. There were several reasons in the past where Mayo clinic doctors indicated that CyBorD was advantageous over RVD, but the main reason I think was that Revlimid could be help back for relapse. Now that there are newer approved drugs, it seems they just dropped that approach, and moved RVD into the front line for all settings (as there are more relapse options now).

Secondly, Kyprolis was brought into the mix for the first time, not across the board, but for high risk.

I think that the natural progression will be that KRD (Kyprolis, Revlimid, dexamethasone) will replace RVD. When we started induction for my wife last year, we had researched that Kyprolis was probably better, but it was not approvable off trial for initial induction, and there was not an appropriate clinical trial that would fit our situation. Now, I heard that only in the past couple of months at the center we go to, MSKCC in NY, that KRD is being used front line, so long as insurance will approve it.

Bottom line is that there does appear to be progress in improved approaches and combos for front line and early relapse, and that its good to stay on top of these as it might relate to each person's situation.

Good luck to all.

[Tracy J]

Re: Update to Msmart guidelines - newly diagnosed myeloma

by Tracy J on Fri Dec 04, 2015 10:41 am

It will be interesting to see if carfilzomib (Krypolis) really does become frontline therapy, given that some myeloma experts seem to think it has a high rate of cardiopulmonary side effects, like congestive heart failure and pulmonary hypertension. If those rates turn out to be too high, it's not going to be a good choice for front line therapy. Only data will tell.

By the way, my diastolic dysfunction and pulmonary hypertension seem to be resolving quite nicely. I feel pretty good. I'm spending this winter knitting and training for next year's hiking season. I have the Grand Canyon and eleven 4,000 foot mountain to hike!

[Multibilly]

Re: Update to Msmart guidelines - newly diagnosed myeloma

by Multibilly on Fri Dec 04, 2015 10:44 am

JPC,

Thanks for posting this.

I think a couple of other notable changes are the inclusion of gene expression profiling (GEP) and PC (plasma cell) S-phase percentages (percentage of myeloma cells that are actively replicating their DNA, as measured by flow cytometry) in determining risk.

[JPC]

Re: Update to Msmart guidelines - newly diagnosed myeloma

by JPC on Sat Dec 05, 2015 11:44 am

Hi Tracy: I am very glad to hear your potentially serious side effects from Kyprolis have receded. Good luck with the Grand Canyon!!!