Dr. Borello on Treating Indolent Versus Aggressive Relapsed Multiple Myeloma

Ivan M. Borrello, MD, associate professor of oncology, Johns Hopkins Medicine, discusses treatment for patients with indolent versus aggressive relapsed multiple myeloma.

Whether the relapse is early or late is not as important as whether it's aggressive or indolent and in what setting it occurs, says Borrello. In addition, a patient’s comorbidities must be taken into consideration when selecting treatment.

Since patients with this disease have a median age of 65, a significant number of them will have comorbidities. Notably, if a patient has preexisting neuropathy, proteasome inhibitors such as bortezomib (Velcade) and ixazomib (Ninlaro), may not be the best choice as they can cause neuropathy. Moreover, patients with preexisting cardiac dysfunction may not be best suited to receive carfilzomib (Kyprolis), adds Borrello.

In addition to patient characteristics, the type of response patients had to prior treatment should also be taken into account. This information can help determine whether a patient with relapsed indolent disease could benefit from the addition of 1 drug to their prior regimen, or whether a patient with aggressive relapse would require a complete regimen change, concludes Borrello.