Myeloma   

Given the rarity of this diagnosis (5-7% of all AL amyloidosis cases), and the prognostic and clinical differences when compared to non IgM-AL am...

What factors (i.e. timing from transplant, dose, prior therapy) impact your decision? 

We know the longer we expose patients to lenalidomide, the harder collection will be. Would you collect now or switch to an alternative regimen to ach...

Do the results change your clinical practice?

E.g. in a patient with tenuous cardiac function, would starting treatment several weeks earlier potentially improve outcomes?

Does measuring serum free-light chains make a 24-hour UPEP unnecessary?

Does a progressing kappa/lambda ratio > 100 at any point in time warrant treatment, or does one wait to treat patients in the setting of a slowly i...

What agents would have sufficient efficacy overlap to treat both?

Would you avoid imid's given reported association with transplant rejection?

For pts w/ eGFR between 30-60

Frailty Index per Palumbo et al. PMID 25628469Is it practical to apply in clinics? Have you made decision changes based on it?

Venetoclax has demonstrated efficacy in patients harboring t(11;14) mutations but is not FDA approved for MM. Can you expand on what situations you ma...

Are the early results of CASSIOPEIA (Abst 8003) from ASCO 2019 practice changing? What about the GRIFFIN results in 2020?

Do you modify the aspirin dose based off the lenalidomide dose? Do you ever use higher dose aspirin in lieu of an anticoagulant? The NCCN guidelines s...

For example: shorten IMiD duration each cycle, add scheduled G-CSF, add antibacterial prophylaxis, etc.

How do you decide how long to continue?

CAR-T (any specific preference of product?) vs bispecific antibodies vs any other specific agents not previously utilized?

Is a repeatedly abnormal serum immunofixation all it takes for MGUS?

DaraCyBorD: daratumumab, cyclophosphamide, bortezomib, dexamethasone

Would you continue with daratumumab maintenance per ANDROMEDA or switch regimen?

After 3-4 cycles of RVD, would you automatically take the patient to transplant if he has achieved at least a partial response, or is there any benefi...

If you do recommend resuming carfilzomib, what dose and frequency would you use?

What about multiple anaplastic plasmacytoma without bone marrow involvement?

Can you expand on this by sharing exactly what this routine workup should include? What additional tests outside of evaluating for POEMS and amyloidos...

How much weight do you give to a hgb/hct threshold versus symptoms?

Insurance won't pay for harvesting if the transplant is not done within a year.

Would you use MRD status to guide your decision making? 

If so, venetoclax/dexamethasone by itself or do you include a PI?

Is the therapeutic purpose of the proteasome inhibitor to maximize total dosage per week or number of infusions per week?

Recommendations in guidelines are discordant (ASCO vs NCCN vs UptoDate).

If yes would you delay initiation of antineoplastic therapy to allow time for the vaccine to start acting?

When do you start treatment in this case?

How is this impacted by patient features, cytogenetics/disease biology, depth of response, or other factors? What would compel you to continue 3 drugs...

How do you factor in patient age, frailty, patients with underlying organ dysfunction, or other clinical features? Do you still consider CyBorD or R...

Do you opt for VRd, DaraRD, CyBorD or another regimen?  How would this change for a patient with high risk cytogenetics?

In your experience, do certain regimens have more cumulative toxicity, financial impact, or patient convenience factors?

Are there scenarios where you would use a higher dose of lenalidomide in a novel doublet or triplet (eg. relapse on lenalidomide maintenance)?

When would you consider utilizing autologous SCT in those with a PR or SD? Is there a potential role for BCMA-directed CAR-T or bispecific therapy in...

How do you distinguish this entity from other plasma cell disorders (eg. MGUS, MM, etc.)?   Review of literature suggests that most of these pa...

What regimens would you consider combining it with? Any specific combinations to avoid or special considerations?

Excluding clinical trials

For example, in cold agglutinin disease or AIHA, antibodies can be detected via DAT, but are often not observed on assays for monoclonal gammopathies.

Does your management change based on the type of end-organ involvement at the time of diagnosis? Are there any reports of CNS involvement with non-se...

Is there concern for impaired healing? Do you pause therapy and for how long?

Is there any data justifying the use of systemic therapy over localized therapy (e.g. radiation or surgery) in this situation prior to a progression e...

Given the recent reclassification of gain(1q21) as a high risk cytogenetic abnormality, has this changed your practice in managing newly diagnosed pat...

Is there evidence for daratumumab-based doublet regimens? Would your choice differ based on the patient's transplant eligibility?

For example, for joing replacement surgery? Do you hold the revlimid for certain about of time before and after?

Does your choice of agent differ, or are you more or less likely to offer maintenance than if the patient had multiple myeloma alone?

Would your approach change based on the type of reaction (eg. Stevens-Johnson syndrome vs DRESS)? How would you address maintenance (if any) post-tra...

Do you worry about the ability to collect stem cells (at the time of progression to MM) if someone with SMM has been on prolonged lenalidomide?

What features are used to distinguish anaplastic multiple myeloma (AMM), and what other conditions should be considered in a differential diagnosis (e...

To me, the recent NEJM study is flawed in that the control arm did not have maintenance treatment while the experimental arm used maintenance Dar...

Would you recommend surgical resection if feasible? Or just monitor every 3-6 months as NCCN guidelines suggest? Would your management differ based o...

Would you proceed to autologous transplant, or switch to an alternate regimen (eg. daratumumab-based) first? Would the type or degree of organ involv...

If so, what is your approach to laboratory and clinical testing?

Once a tissue biopsy has confirmed light chain amyloid, what additional tests do you perform as part of a standard workup? In whom should treatment b...

Are there specific patient groups where you would choose one over the other? Are the cost differences significant enough to dissuade you from choosin...

Do these events mandate discontinuation of lenalidomide therapy or switching to a different agent? Can appropriate therapy for these skin cancers be r...

Given the PFS benefit seen in the most recent ECOG-ACRIN, and the prior study of Rd showing an OS benefit, is your practice to put any high-risk SMM p...

For example - Would you offer tandem transplantation in a young, fit patient in a CR after first transplant, but with MRD detectable?

Although the MMR vaccine is contraindicated in immunosuppressed patients on anticancer treatment according to CDC/ACIP and IDSA guidelines, data on sa...

Given the recent results presented from the Griffin trial, would you choose a daratumumab-based regimen (eg. D-VRd) over other salvage options (V...

Has the recent data presented at ASH affected your choice of regimen? Would your choice differ between transplant-eligible and transplant-ineligible ...

Would MRD assessments affect your clinical decision making for MM patients outside of a clinical trial?

Specifically, what regimen would you choose in a patient with new renal failure but not requiring dialysis?

Does the choice of initial induction regimen affect your decision for when to employ lenalidomide maintenance? Are there situations where you would c...

Would you change to an alternative triplet therapy, or switch to maintenance therapy? Are there variations in depth of response short of CR that woul...

Would you observe until progression or would you place the patient on maintenance?

Once you decide to begin treatment, any special precautions you would use for protein levels starting that high.

Subq has been shown to have lower risk of neuropathy. Is there any reason to use weekly IV still?

In a patient with multiple poor risk features including TP53 mutation, 1q amplification, stage III, and circulating plasma cells, would you consider a...

For example, how significant does the M protein have to increase for you to begin a conversation about new therapy?

Specifically, to you lean towards elotuzumab or a daratumumab-based regimen?

Would you ever give another IMiD?

At what point is the neuropathy a contraindication to further bortezomib therapy?