At the 2nd Annual HemOnc Pulse Live! event held in Austin, TX, a panel discussion led by Saad Z. Usmani, MD, MBA, of Memorial Sloan Kettering Cancer Center, focused on therapeutic strategies and unanswered questions in the management of relapsed multiple myeloma. The panel of experts engaged in a clinical exchange spanning treatment sequencing, immune system dynamics, and directions for future research.
Panelists:
- Caitlin Costello, MD, UC San Diego Health
- Peter Voorhees, MD, Atrium Health Levine Cancer Institute
- Sham Mailankody, MBBS, Memorial Sloan Kettering Cancer Center
The discussion began with the role of daratumumab in relapsed disease and the rationale for reserving its use until patients develop active multiple myeloma. This led to a broader conversation about inflammation in precursor disease states such as monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma. The panel debated whether anti-inflammatory therapies might delay disease progression and referenced ongoing or prior studies involving agents such as canakinumab, luspatercept, and leflunomide.
Despite these efforts, panelists noted that early-stage interventions have had limited impact on altering disease trajectory, citing immune escape mechanisms as a likely driver of progression. Key themes included CD8+ T-cell dysfunction, T-cell exhaustion, and the loss of cytotoxic immune responses in advanced disease. The discussion referenced findings from single-cell sequencing and spectral flow cytometry, underscoring the importance of understanding immunologic transitions from healthy marrow to overt multiple myeloma.
Missed the frontline myeloma conversation? Listen now on the HemOnc Pulse.
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