BonumCE Malignant Hematology CME

[BonumCE Malignant Hematology CME @BloodCancerCME]

👋 #OncTwitter & to anyone 🆕 here

👥We're a specialty handle from @BonumCE, a CME/CE provider for HCPs

📍We develop 🩸 #hematology CME/CE directly on SoMe channels, 👍like Twitter🐦

Stop by, say 👋, happy you're here!

[Joseph Mikhael @jmikhaelmd]

#MMSM #OncTwitter #oncX
⚡️Join me & my colleague @DrKrinaPatel

🧵Explore efficacy of 1L quad tx #NDMM
🔬PERSEUS, GMMG-HD7 & CONCEPT, CEPHEUS, IMROZ, ADVANCE, MIDAS +++

🆓#CME👉🏼 https://t.co/FFX9Aegd07
Supported by an edu grant from @JNJInnovMed

📍First, what's your specialty?

[Joseph Mikhael @jmikhaelmd]

2/ Before we jump in, a few disclosures & important links🔗

1️⃣📖#CME info https://t.co/FFX9Aegd07
2️⃣Take the pre-survey👉https://t.co/WGopsDHpIU
3️⃣Get latest NDMM quad tx efficacy data w/🧵👇
4️⃣🏆Claim🆓CME https://t.co/P8RgrAAXG4

⏱️Now, let's get started!

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME 3/🥼In your practice, which regimen are you using most often for 1L therapy in pts w/ transplant eligible (TE) #NDMM?

☎️Phoning friends, what do u do?@nsc_natalie @bendermanmd @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos #mmsm

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos 4/💃Quads are taking center stage in NDMM
Let’s look @ the📈 on quad tx

PERSEUS ~🔑trial: SQ dara➕VRd➡️↑outcomes in TE pts

👉↑PFS @ 48m 84.3 v 67.7%; HR: 0.42; P<0.001
👉↑MRD- rate 75.2 v 47.5%; P<0.001
👉↑CR rate 87.9 v 70.1%; P<0.001
🎉🆕#SOC ~ quad instead of triplet🎉

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos 5/PERSEUS #ASCO25: sustMRD- in pts on quad maint @ median f/u 47.5m

↑ sustMRD- @ ≥24m w DVRd v VRd: 55.8 v 22.6%
👉Pts w ≥12m sustMRD-: ↑48m PFS, regardless of tx
👉Only 3.1% progressn @ 18m w DVRd v 6.8% VRd
🔑DVRd➡️2.5x⬆️≥24m sustMRD- & ½progressn risk@≤18m tx
@mbeksac56

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj 6/🙋🏻What about replacing dara- with isa- in a quad?

GMMG-HD7
IsaVRd v VRd induction➡️isa-len v len maintenance in TE NDMM

👉↑ MRD- rate 50% v 36%; p =0.00017
👉IsaVRd had ↓AE rates & ↓d/c rates v RVd

🎉🆕SOC
👉Results➡️addition of IsaVRd as induction regimen for TE NDMM

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj 7/⚡️GMMG-HD7 #ASCO25 update w/ PFS benefit in all quad recipients

↑CR 43.5% w IsaVRd v 34% w VRd
↑MRD- rate 66.2% w quad v 47.7% w triplet
👉PFS at 3yr benefit: 83% v 75% w/ IsaVRd v VRd
↑MRD- regardless of maint v MRD+ (HR 0.61; P=0.002)
🔮Maint w Isa-len v len is on-going

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser 8/🔬Exciting news for #mmsm
Quad tx as🆕SOC for #NDMM

Current @EHA_Hematology/@EMN_EuMMnet (1st optn) & @NCCN (pref,cat 1) regimens for TE pts w/NDMM:
🎯DaraVRd➡️SCT➡️len maint
🎯IsaVRd SCT➡️len maint

👏to quad as 1L for TE pts👏
…but what about pts who are TIE /SCT-deferred?

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN 9/
CEPHEUS compared induction/consolidation w VRd ± daratumumab (D) followed by maintenance in transplant-ineligible (TIE) #NDMM

🗳️The DVRd arm demonstrated which of the following outcomes?

#mmsm @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman 10/ CEPHEUS🔑trial in TIE & SCT-deferrd pts
DVRd➡️deeper, more durable MRD- rate

TIE cohort:
👉Overall MRD- 63.2 v 41.4%
👉SustMRD @ ≥12m 48.7 v 26.3%; P<0.0001
👉CR 81.2 v 61.6%; P<0.0001
👉HR 0.57, 95% CI 0.41-0.79; P=0.0005
↓D/C rate w quad

🎉DVRd new SOC for TIE NDMM🎉

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman @End_myeloma @SagarLonialMD @DrOlaLandgren @SLentzsch @NoopurRajeMD 11/#MMSM Do results w isa show similar trends?

IMROZ🔑trial
IsaVRd➡️IsaRd v VRd➡️Rd in TIE pts w NDMM

👉IsaVRd ➡️↓time to MRD-: 14.7 v 32.8m
👉↑ PFS @ 60m: 63.2 v 45.2%; HR: 0.60; P<0.001
👉↑ CR: 74.7% v 64.1%; P=0.01
IMROZ results support IsaVRd as 🎉🆕SOC for TIE #NDMM pts

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman @End_myeloma @SagarLonialMD @DrOlaLandgren @SLentzsch @NoopurRajeMD @thanosdimop @PlasmaCellPete @FaithEDavies1 @HiraSMian @TomBmt133 @OcioEnrique 12/BENEFIT eval'd wkly bortezomib (V) in TIE NDMM

IsaVRd➡️IsaVR➡️IsaR v IsaRd➡️IsaR➡️IsaR
↑MRD- rate at
12mo 51% v 21%; OR: 3.88; 95%CI: 2.27-6.62;P<0.0001
18mo 53% v 26%; OR: 3.16; 95%CI: 1.89-5.28;P<0.0001

🔑Wkly V in IsaRd=deep responses
Supports IsaVRd as🆕SOC for TIE NDMM

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman @End_myeloma @SagarLonialMD @DrOlaLandgren @SLentzsch @NoopurRajeMD @thanosdimop @PlasmaCellPete @FaithEDavies1 @HiraSMian @TomBmt133 @OcioEnrique 13/🆕SOC for pts w SCT-deferred or TIE #NDMM🎉

NCCN (preferred, cat 1) & EHA-EMN (1st optn) regimens:
🎯DRd ‘til progression; de-escalate prn
🎯DVRd ‘til progression; de-escalate prn(<80 yr old, not frail)
🎯IsaVRd ‘til progression; de-escalate prn(<80 yr old, not frail)
#MMSM

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman @End_myeloma @SagarLonialMD @DrOlaLandgren @SLentzsch @NoopurRajeMD @thanosdimop @PlasmaCellPete @FaithEDavies1 @HiraSMian @TomBmt133 @OcioEnrique 14/Unfortunately, pts w high-risk (HR) #NDMM have 👎poorer prognosis & shorter survival rates vs standard-risk

Based on results of GMMG-CONCEPT presented at #ASCO2025, which treatment strategy should be used for pts w/ HR NDMM?

🔑Key:
🔸MRD- = Treat to MRD-
#mmsm #OncTwitter

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman @End_myeloma @SagarLonialMD @DrOlaLandgren @SLentzsch @NoopurRajeMD @thanosdimop @PlasmaCellPete @FaithEDavies1 @HiraSMian @TomBmt133 @OcioEnrique 15/👏if you chose to treat to MRD- & cont maint

GMMG-CONCEPT, largest cohort to eval MRD- in TE & TIE HRNDMM

IsaKRd inductn & consolidatn➡️IsaKR maint➡️
↑MRD- rate: 67.7% in TE & 54.2% in TIE
Sustained ≥1yr: 62.6% in TE & 46.2% in TIE

🎉IsaKRd➡️↑deep remissions
@Mohty_EBMT

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman @End_myeloma @SagarLonialMD @DrOlaLandgren @SLentzsch @NoopurRajeMD @thanosdimop @PlasmaCellPete @FaithEDavies1 @HiraSMian @TomBmt133 @OcioEnrique @Mohty_EBMT 16/📣GMMG-CONCEPT ASCO2025 update, TE pts:
73.2% MRD- post-consolidatn; p=1.91x10-13
86.8% MRD- @ any time
58.4% MRD- ≥CR
40.6% retained ≥2yr sust MRD-

Med follow-up: 43m(0-90.2m)
mPFS: 72.8m
5yr OS: 72%
6yr OS: 69%
⬆️2yr sustMRD-, ⬆️PFS, 69% OS @ 6yr

IsaKRd:🆕SOC for HRNDMM

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman @End_myeloma @SagarLonialMD @DrOlaLandgren @SLentzsch @NoopurRajeMD @thanosdimop @PlasmaCellPete @FaithEDavies1 @HiraSMian @TomBmt133 @OcioEnrique @Mohty_EBMT @HarethNahi @DrRakeshPopat @UrviShahMD @HadidiSamer 17/ADVANCE🔑trial demonstrating dara+ standard KRd ➡️↑outcomes in NDMM independent of TE

↑MRD- rate: 59% v 36%, adjOR = 2.5; P<0.0007➡️ 2.5x ↑MRD- rate w/DKRd
👉No new safety concerns
❓Impact on EFS, PFS & OS TBD

DKRd👉1L for all pts on KRd backbone regardless of TE status

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman @End_myeloma @SagarLonialMD @DrOlaLandgren @SLentzsch @NoopurRajeMD @thanosdimop @PlasmaCellPete @FaithEDavies1 @HiraSMian @TomBmt133 @OcioEnrique @Mohty_EBMT @HarethNahi @DrRakeshPopat @UrviShahMD @HadidiSamer 18/ Looking across trials... e.g.
🔬CEPHEUS
🔬IMROZ
🔬GMMG-CONCEPT
🔬ADVANCE…

🥅MRD negativity emerges as benchmark to create a level playing field
Across🔬, regimens and now✅FDA approved as a clinical trial endpt as of April ‘25

#MMSM #OncTwitter #OncX #MedTwitter #MedX

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman @End_myeloma @SagarLonialMD @DrOlaLandgren @SLentzsch @NoopurRajeMD @thanosdimop @PlasmaCellPete @FaithEDavies1 @HiraSMian @TomBmt133 @OcioEnrique @Mohty_EBMT @HarethNahi @DrRakeshPopat @UrviShahMD @HadidiSamer 19/MIDAS eval’d MRD-guided consolidatn post 1L IsaKRd in TE NDMM

Post 1L, no🔼in MRD- rates for all pts
Tailoring tx to MRD post 1L may not➡️MRD-
If respond to 1L tx may not need tandem SCT to reach MRD-; cont anti-CD38 &PI

🤔High # pts w t(11;14): impact time to MRD- results?

[Joseph Mikhael @jmikhaelmd]

@DrKrinaPatel @Global_CME @BonumCe @BloodCancerCME @nsc_natalie @szusmani @Ccostello7 @Ashley_Rosko1 @AnnaSureda5 @ravivij @hhashmi87 @SurbhiSidanaMD @mvmateos @mbeksac56 @AnnemiekBroijl @H_Einsele @PerrotAurore @paurotero @MyelomaOslo @MaiolinoAngelo @chngwj @EliasKarlMai @andrew02114 @RaabMarc @MyMKaiser @EHA_Hematology @EMN_EuMMnet @NCCN @AjaiChari @dra_v_hungria @docbraunstein @NBahlis @RahulBanerjeeMD @Bethfaiman @End_myeloma @SagarLonialMD @DrOlaLandgren @SLentzsch @NoopurRajeMD @thanosdimop @PlasmaCellPete @FaithEDavies1 @HiraSMian @TomBmt133 @OcioEnrique @Mohty_EBMT @HarethNahi @DrRakeshPopat @UrviShahMD @HadidiSamer 20/🔑1L in TE & TIE for NDMM SUMMARY🔑

🎯Triplet WAS standard approach, but quad is🆕SOC
🎉Quad is preferred 1L for TE NDMM v triplet
🆕SOC: IsaRVd for TIE NDMM🎉
🎯MRD- emerging as a benchmark in🔬 & clin decision making
👏Great news for pts

#MMSM NEXT answer Qs & claim #CME👇