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MULTIPLE MYELOMA, GAMMOPATHIES

Treatment outcomes of triple class refractory multiple myeloma: a benchmark for new therapies

Leukemia volume 36, pages 877–880 (2022)Cite this article

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To the editor:

The outcomes of patients with newly diagnosed multiple myeloma (MM) continue to improve with a deeper understanding of disease pathobiology, expansion of the therapeutic armamentarium and improvements in supportive care [1]. The development of proteasome inhibitors (PIs), immunomodulatory agents (IMiDs), and anti-CD38 monoclonal antibodies (CD38Moabs) and their uptake into earlier lines of therapy has revolutionized the field producing rapid, deep, and durable disease control. However, MM almost invariably relapses and ultimately patients die from refractory disease [2]. The management of triple class refractory (TCR) MM (refractory to PIs, IMIDs, and CD38Moabs) is a modern therapeutic challenge [3]. Novel classes of agents such as exportin-1 inhibitors, chimeric antigen receptor T cells, T cell redirecting antibodies, and antibody-drug conjugates are in various stages of clinical development and regulatory approval. Assessment of their relative impact and incremental value in the TCR setting is impaired by limited evidence from prospective randomized trials or benchmarks for therapeutic outcomes when available drugs are deployed in this setting. We sought to characterize and delineate therapeutic outcomes of TCR MM.

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Fig. 1: Outcomes of patients with triple class refractory multiple myeloma.

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Authors and Affiliations

  1. Division of Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USA

    Susan Bal, Kelly N. Godby, Smith Giri & Luciano J. Costa

  2. University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Ehsan Malek

  3. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Ankit Kansagra

  4. Levine Cancer Institute/Atrium Health, Charlotte, NC, USA

    Saad Z. Usmani

  5. Washington University in St. Louis, St Louis, MO, USA

    Ravi Vij

  6. Vanderbilt University, Nashville, TN, USA

    Robert F. Cornell

  7. Duke University, Durham, NC, USA

    Yubin Kang

  8. University of Vermont, Burlington, VT, USA

    Elvira Umyarova

  9. Medical College of Wisconsin, Milwaukee, WI, USA

    Saurabh Chhabra & Parameswaran Hari

  10. Stanford University, Stanford, CA, USA

    Michaela Liedtke

  11. University of Wisconsin, Carbone Cancer Center, Madison, WI, USA

    Natalie S. Callander

  12. Department of Hematology, Mayo Clinic Rochester, Rochester, MN, USA

    Shaji Kumar

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Contributions

The authors confirm contribution to the paper as follows: study conception and design: all authors. Data collection: all authors. Analysis and interpretation of results: all authors, draft manuscript preparation: SB and LC. All authors reviewed the results, critically revised it for important intellectual content and approved the final version of the manuscript.

Corresponding author

Correspondence to Susan Bal.

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Competing interests

EhM: Consultancy and Speakers Bureau (Takeda, Celgene, Amgen, Janssen); ML: Consultancy (Amgen/Onyx), Honoraria (Amgen/Onyx, Pfizer, Prothena, Takeda), Research Funding (Amgen/Onyx, BlueBirdBio, Celgene, Genentech/Roche, Gilead, Pfizer, Prothena, Takeda), Membership on an entity’s Board of Directors or advisory committees (Caelum, Pfizer, Prothena, Takeda); PH: Consultancy and Research Funding (Amgen, Celgene), Honoraria (Celgene); RV: Honoraria (Celgene, Bristol Myers Squibb, Takeda, Amgen, Janssen, Karyopharma, Jazz), Research Funding (Celgene, Bristol Myers Squibb, Takeda); SU: Consultancy (Abbvie, Amgen, Celgene, Genmab, Merck, MundiPharma, Seattle Genetics), Research Funding (Amgen, BMS, Celgene, Janssen, Merck, Pharmacyclics, Takeda), Membership on an entity’s Board of Directors or advisory committees (Sanofi); ShK: Consultancy (AbbVie, Celgene, Janssen, Kite Pharma, Merck, Takeda); LC: Honoraria (Amgen, Celgene, AbbVie), Research Funding (Amgen, Celgene, Janssen). SB has received research funding from Amyloid Foundation. SG is supported in part by the Walter B. Frommeyer Fellowship in Investigative Medicine at the University of Alabama at Birmingham and reports receiving research funding from Carevive Systems and Pack Health. SC: Research Funding: Amgen, Janssen, Sanofi; Honorarium: Glaxo Smith Kline. Other authors do not have any conflicts of interest to disclose.

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Bal, S., Malek, E., Kansagra, A. et al. Treatment outcomes of triple class refractory multiple myeloma: a benchmark for new therapies. Leukemia 36, 877–880 (2022). https://doi.org/10.1038/s41375-021-01471-3

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