Beth Faiman, PhD, CNP, discusses reclassifying patients with multiple myeloma, the accelerated approval of teclistamab, and the removal of belantamab mafodotin from the US market.
In this episode of The Vitals, Beth Faiman, PhD, CNP, weighs in on the current trajectory of research and clinical practice in multiple myeloma.
Faiman is a nurse practitioner and researcher with the Cleveland Clinic, as well as a board member of the NP/PA Center of Excellence in Multiple Myeloma. According to her, one of the biggest changes of late was the publication of a study in Lancet Discovery, findings of which suggest that patients with biomarker-defined defined disease, as well as 60% or more bone marrow plasma cells (BMPCs), or a free light chain ratio (FLCratio) of at least 10, have a longer time to progression and a lower 2-year progression risk than was previously believed.1 Whereas the median time to progression was previously reported to be 9.2 months, the new study found the median time to be 30.1 months. Moreover the 2-year progression risk was 45.45%, rather than the previously reported 85.21%.
As Faiman points out, in 2014, the International Myeloma Working Group had added patients with at least 60% BMPCs, FLCratio equal to or greater than 100, and greater than 1 MRI-defined focal lesion of at least 5 mm (SLiM CRAB multiple myeloma) to the diagnostic category of multiple myeloma. However, this newer review suggests that this classification may need to be revisited.
Faiman also touches on shifts in approved BCMA-directed therapies for patients, namely, the accelerated approval of teclistamab-cqyv (Tecvayli) in October of 2022, and the removal of belantamab mafodotin-blmf (Blenrep) from the market in November 2022.2,3 She notes that there are ongoing efforts to reincorporate belantamab mafodotin into clinical practice and that she is optimistic about reintroducing this treatment back into her practice—as the dosing schedule and toxicity profile was favorable for patients.
“Supporting [a] patient while they are in their maintenance phase [of treatment]; checking the blood counts, keeping up [with] health maintenance, making sure their bones are strong and all those other supportive care things, are so important.”
“If you have a heavily pretreated patient on some of the new cellular therapies or bispecifics, that they have to be admitted to the hospital, we have to logistically manage who’s going to be admitted on what day and when.”
“The nice thing about belantamab was that it was an [intravenous] IV [therapy] every 3 weeks, it is directed against BCMA, and it was very well tolerated.”
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