EHA 2024: Multiple myeloma roundup

Dr Claudio Cerchione - IRCCS, Meldola, Italy

Hello everybody, I’m Claudio Cerchione working at the Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" in Meldola. It is a great pleasure to have participated to both ASCO 2024 and EHA 2024 where I can confirm that the revolution in multiple myeloma is continuing. We have many new drugs, many new combinations, starting from the front line setting in which we have seen exciting data from a new combination - monoclonal antibody anti-CD38 is the backbone with daratumumab or isatuximab. We have seen consolidated data from the GRIFFIN study and from the EMERALD study – GRIFFIN is dara-VRd, EMERALD is isatuximab-VRd. In both the combinations I can say we are going to achieve very good results in terms of fast response, great efficacy and also MRD negativity in a high rate of the population. The outcome, the take-home message from these studies is that MRD negativity should be the real endpoint, particularly in the young, fit and transplant eligible population.

In the relapsed/refractory setting we have seen a wonderful reworking of belantamab mafodotin thanks to the data of DREAMM-7 and DREAMM-8 in which belantamab has been combined with bortezomib and with pomalidomide. I’m particularly happy to have contributed as co-author to The New England Journal of Medicine in DREAMM-7. In both the combinations we see that we are potentially in front of a new standard of care thanks to the progression free survival analysis but also thanks to the great tolerability. In fact, if we were to anticipate belantamab mafodotin to the earlier lines of treatment, we see that the tolerability is not bad like we had seen in later lines of therapy. So maybe this is also related to the burden of disease and to something that the patients can achieve in the following line. I think that we can achieve a wonderful efficacy and also a really great tolerability with also very good patient reported outcomes. The two combinations are potentially game changers in the next future.

Let’s not forget selinexor, bortezomib and dexamethasone, also for the same setting of patients, particularly lenalidomide refractory. Good efficacy, good tolerability, very good compliance, a good schedule.

Let’s not forget that we are going to explore also new ways of performing treatment. There is a new way of interpreting chemotherapy which is melflufen. Melflufen is another option that we can use in patients who are immunotherapy refractory. Then for other patients we have seen a consolidating result of new cellular therapies with specific antibodies elranantimab and teclistamab are showing exciting data also at long term. They are manageable if we perform a very good prophylaxis with intravenous IG and we know now how to supplement our patients. We are going to explore also real-world analyses with these drugs.

I am particularly appreciative also that the CAR T are showing confirmation in the real world but also that they are going to be anticipated. Particularly, I presented the abstract in which it was shown the role of combination of a CAR T together with lenalidomide in the maintenance setting, this could be another potential game changer, the idea of having a better response, a better maintenance of response after autologous stem cell transplantation.

What about the others? I think that we are going to confirm that we have many drugs, we have to concentrate on sequencing. We have to optimise the use of the drugs and the combinations that we have available, improving the proliferation of our patients. That’s why in my institution we are improving new multi-omic tools that in some way can improve the diagnostics in newly diagnosed relapsed/refractory and in smouldering myeloma, in some way increasing the attention to diagnostics with whole-body MRI combined with PET/CT with molecular evaluation with a SKY92 panel, the metabolomic assay and also the clinical evaluation. These, together with an MRD evaluation with the correct monitoring. We need a new prognostic score and I dream that from data of my institution we will have that as soon as possible.

All this to confirm that for our patients the cure is not so far and this is the best wish that I give to the patients, to the caregivers and to all melanoma researchers that every day fight against this disease.