[TerryH]

Updated mSMART treatment guidelines for relapsed myeloma

by TerryH on Mon Dec 14, 2015 4:59 pm

Hey everyone,

The Mayo Clinic has updated its treatment guidelines for relapsed multiple myeloma to take into account the FDA approvals of daratumumab, ixazomib, and elotuzumab. Here is a link to the updated guidelines:

http://nebula.wsimg.com/6c6ce81602349729f49f567b4d6e761a?AccessKeyId=A0994494BBBCBE4A0363&disposition=0&alloworigin=1

[Multibilly]

Re: Updated mSMART treatment guidelines for relapsed myeloma

by Multibilly on Mon Dec 14, 2015 6:12 pm

That was unbelievably fast given these drugs were just approved. They just did a major mSMART revision a couple of weeks ago, sans any of the just-approved drugs.

[coachhoke]

Re: Updated mSMART treatment guidelines for relapsed myeloma

by coachhoke on Mon Dec 14, 2015 11:48 pm

The type of treatment that they recommend seems pretty clear; but as Multibilly knows, I still have problems determining (I know the definition off relapse) when to re-start treatment. I understand m-spike and free lite and CRAB features. What is m-SMART's definition of relapse?

Thanks,
Coach Hoke

[TerryH]

Re: Updated mSMART treatment guidelines for relapsed myeloma

by TerryH on Tue Dec 15, 2015 12:54 pm

Hi Multibilly - I agree. That was fast. Just one clarification, though. As you probably noticed already, the revisions in this case are to the guideline for relapsed myeloma patients. The other revisions you mentioned that were announced not so long ago were for the mSmart guidelines for newly diagnosed patients.

CoachHoke - I'm sure that Mayo uses exactly the same definitions for relapse and progression that have been posted and explained many times here in the forum by different patients and physicians. As I recall, those definitions were set up by the International Myeloma Working Group, and they haven't changed much in the past 5-10 years.

[rumnting]

Re: Updated mSMART treatment guidelines for relapsed myeloma

by rumnting on Wed Dec 16, 2015 10:01 am

My husband is quad-refractory. He is scheduled to begin Darzalex after the holidays here in Michigan. The day after the new mSMART guidelines came out, his doctor from Mayo called to say that he wanted my husband's local oncologist to add in Pomalyst and dex. Nice to know your multiple myeloma expert who is 500 miles away keeps your case in mind!

[DallasGG]

Re: Updated mSMART treatment guidelines for relapsed myeloma

by DallasGG on Wed Dec 16, 2015 11:11 am

I read the guidelines for my situation. According to the document, I'm standard risk. My initial therapy was Revlimid, Velcade, and dex (RVD), which got me to a complete remission, followed by an autologous stem cell transplant (ASCT) and then maintenance with Revlimid / dex. I'm still in remission on the Revlimid / dex maintenance at about 2 years post ASCT.

Wouldn't it make sense to retry RVD at first relapse rather than use Kyprolis, Pomalyst, and dex (KPd) or cyclophosphamide, Velcade, and dex (CyBorD), which is the recommended treatment, given that RVD worked so well the first time? Why try other drug combinations when the first one worked so well? Wouldn't you want to hold the newer drugs for trying later if / when the RVD stopped working? Is Mayo not using RVD anymore?

Any comment on this? Or has anyone actually had a similar scenario and what they tried at first relapse? Or is faced with this situation now?

[Spirit]

Re: Updated mSMART treatment guidelines for relapsed myeloma

by Spirit on Wed Dec 16, 2015 3:50 pm

Hi Dallas,

I don't know if this will answer your question but this is my situation. I relapsed on RVD in June and developed multiple plasmacytomas. The doc told me I had become refractory to Revlimid and Velcade.

He started me on Kyprolis, Pomalyst, Cytoxan and dex. My PET scan in September was clear. Amazing that it worked so fast. Not sure if I will ever respond again to Revlimid or Velcade again since I became refractory to it after just four months.

Spirit