Based in China, looking to the world｜Following the new progress of MM, exploring new ideas of diagnosis and treatment, CACA guideline tour and POST-EHA/ASCO MM special meeting was successfully held!

Multiple myeloma (MM) is the second most common malignant tumor in the blood system, and there is still no cure

The meeting was chaired by Professor Qiu Lugui from the Hospital of Hematology, Chinese Academy of Medical Sciences.

As one of the main authors, Professor An Gang explained in detail the guidelines for the integrated diagnosis and treatment of MM in the CACA series of guidelines

Figure 1 Key advances in the treatment of MM

For MM patients, minimizing tumor burden and maintaining a low tumor burden state are the main therapeutic goals

In the selection of treatment regimens, MM patients who are suitable for transplantation should choose a treatment regimen that can rapidly and effectively control disease progression, is well tolerated, and does not affect the collection of autologous stem cells in the induction therapy stage before autologous hematopoietic stem cell transplantation (ASCT).

Professor Wang Luqun took stock of the latest progress of the 2022 EHA&ASCO annual meeting, and explained the treatment of newly diagnosed MM (NDMM) in simple language

For transplant-eligible NDMM patients, the results of the current study show that the D-VTd regimen resulted in superior and significantly improved depth of response compared with the VTd regimen (bortezomib + thalidomide + dexamethasone).

Figure 2 CASSIOPIA study results

Figure 3 Subgroup analysis results of the GMMG-HD7 study

In addition, the CD38 mAb-based combination regimen also showed good efficacy in NDMM patients who were not suitable for transplantation
.

A subgroup analysis of the MAIA study showed that the DRd regimen demonstrated faster and more durable responses compared with the Rd regimen (Figure 4) ⁴
.

Figure 4 The results of the subgroup analysis of the MAIA study

With the advancement of detection methods, the importance of MRD assessment in MM has become increasingly prominent
.

Multiple studies have shown that MRD negativity predicts better survival outcomes compared with traditional efficacy measures, and further improvements in PFS can be observed with increasing levels of MRD sensitivity
.

At present, many clinical trials have used MRD negativity as the endpoint of efficacy evaluation.
In the future, MRD evaluation may play a more positive role in the dynamic risk stratification of MM patients and guide the selection of treatment options
.

Professor Wang Yafei shared the latest progress in immunotherapy at the 2022 EHA&ASCO Annual Meeting on the hot issues of relapsed/refractory MM (RRMM)
.

In recent years, the availability of MM drugs in China has improved significantly
.

Immunotherapy drugs such as monoclonal antibodies, antibody-drug conjugates (ADCs), bispecific antibodies, and chimeric antigen receptor T cells (CAR-T) have sprung up like mushrooms after a spring rain, and there are more and more treatment options for RRMM patients
.

CD38 mAb has shown superior efficacy and safety in both early relapse and late relapse MM patients after multi-line therapy, and has been recommended by domestic and foreign guidelines as the preferred treatment for ^RRMM5,6
.

Subgroup analyses of POLLUX and CASTOR showed that the combination regimen containing daratumumab prolonged PFS ⁷
in RRMM patients regardless of the time to relapse after first-line therapy .

The results of the ICARIA-MM and IKEMA studies showed that Isatuximab-based treatment significantly prolonged PFS and OS in patients with RRMM, and subgroup analysis showed that it also showed significant survival in patients with advanced age, renal insufficiency, and 1q21+ Benefit ⁸
, 9 .

In addition to CD38 monoclonal antibody, new immunotherapy drugs such as ADC, bispecific antibody, and CAR-T provide more options for RRMM patients
.

Belantamab Mafodotin, a BCMA-targeting ADC, has been approved as a monotherapy for RRMM patients with ≥4 previous lines of therapy, and its combination therapy is currently being explored
.

The results of the phase I/II MajesTEC-1 study showed that Teclistamab, a bispecific antibody targeting BCMA and CD3, was able to achieve deep and durable remission in patients with RRMM and was well tolerated ¹⁰
.

As a CAR-T therapy targeting BCMA, Cilta-cel has carried out a number of key clinical studies.
The long-term follow-up data of the CARTITUDE-1 study further confirmed the efficacy of cilta-cel in the treatment of RRMM, and promoted the approval of Cilta-cel in the FDA.
Approved
.

In recent years, with the continuous emergence of new drugs and the continuous upgrading of detection technology, the treatment of MM has made significant progress
.

The CD38 mAb-based combination regimen has shown good efficacy and safety in both NDMM and RRMM patients, and has been unanimously recommended by domestic and foreign guidelines
.

In addition to CD38 monoclonal antibody, new immunotherapy drugs such as ADC, bispecific antibody, and CAR-T also bring more choices and more hope for cure to RRMM patients
.

Professor An Gang

• Hematology Hospital, Chinese Academy of Medical Sciences, Chief Physician, Associate Professor, Master Supervisor

• State Key Laboratory of Experimental Hematology Level II PI

• Vice-chairman of the Second Youth Committee of Hematology and Tumors of China Anti-Cancer Association

• Member of the Youth Committee of the 11th Committee of the Chinese Medical Association Hematology Branch

• Youth Director of China Anti-Cancer Association

• Member of the Hematology Transformation Committee of the Chinese Anti-Cancer Association

• Member and Secretary of China Multiple Myeloma Research Alliance

• Secretary of the Hematology and Tumor Committee of China Anti-Cancer Association

• Tianjin Anti-Cancer Association Geriatric Oncology Professional Committee

• Member of Tianjin Genetic Advisory Committee

• 2003，2006-2011、；2013/11-2016/5Dana-Farber

• Blood 、Leukemia 、ClinicalCancer Research 、Blood AdvancesSCI10

• /，， （AMN）

• CSCO

• CSCO

• ：、、

[1].
（CACA）——.

[2]Avet Loiseau, et al.
2021 ASH; Abstract 82.

[3]K.
Mai E,et al.
2022 EHA; Poster 930.

[4]Facon T,et al.
2022 ASCO; Abstract 8044.

[5]NCCN Clinical Practice Guidelines in Oncology: Multiple Myeloma.
Version 4.
2022.

[6] Chinese Medical Doctor Association Hematologist Branch, Chinese Medical Association Hematology Branch.
Guidelines for the diagnosis and treatment of multiple myeloma in China (revised in 2022) [J].
Chinese Journal of Internal Medicine, 2022, 61(5) : 480-487.

[7] Shah UA, et al.
BMJ.
2020 Sep 21;370:m3176.

[8] Dimopouios MA, et al.
Leukemia.
2021;35(2):562-572.

[9] Capra M, et al.
Haemalologica.
2022.
107(6):1397-1409.

[10] Moreau P, et al.
N Engl J Med.
2022;10.
1056/NEJMoa2203478.

Approval number: MAT-CN -2218021

statement

1.
This material is intended to convey cutting-edge information, and does not constitute a recommendation or promotion of any drug or diagnosis and treatment program (including drugs under development)
.

2.
The information contained in this material should not replace the medical advice provided by any medical and health professionals.
For specific disease diagnosis and treatment, please follow the opinions and guidance of medical and health professionals.

3.
Isatuximab has not been approved in mainland China

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