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Fonseca Discusses Integrating Biology and Treatment in Multiple Myeloma

Caroline Seymour
Published: Thursday, Apr 19, 2018

Rafael Fonseca, MD

Rafael Fonseca, MD
Although findings from the phase III ALCYONE trial demonstrated the superiority of daratumumab (Darzalex) in combination with bortezomib (Velcade), melphalan, and prednisone (VMP) versus VMP alone, Rafael Fonseca, MD, explains that optimizing frontline therapy for patients with newly diagnosed multiple myeloma remains a work in progress.

State of the Science Summit™ on Multiple Myeloma and Myeloproliferative Neoplasms, Fonseca, a hematologist at Mayo Clinic, discussed the integration of biology and treatment selection for patients with newly diagnosed multiple myeloma.

OncLive: How does the presentation of multiple myeloma differ from other hematologic malignancies?

Fonseca: Myeloma mainly affects people in their 60s and 70s, though it can affect younger individuals. Traditionally, patients present with symptoms of hypercalcemia, renal problems, renal insufficiency, anemia, and bone. Destructive bone lesions are one of the dangerous hallmarks of myeloma. However, renal failure is more dangerous because it is not always reversible. Bone damage can result in compression fractures and, despite our best efforts, can lead to lifelong pain so we want to intervene before that happens. 

What are some prognostic markers?

By definition, every patient with myeloma will have genetic abnormalities. High risk is determined by fluorescence in situ hybridization (FISH), but many people are not using FISH correctly. They’re sending the bone marrow without consideration for sorting or otherwise marking of the cells. Pathology labs are looking at the nuclei of the bone marrow, which doesn’t provide the right information.
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