Multiple Myeloma Advisor Videos: Mikhael

In this video, Dr Joseph Mikhael, hematologist and professor of medicine at the Mayo Clinic in Arizona, discusses treatment combinations for patients with myeloma prior to stem cell transplantation. Pre-transplantation drug combinations help to reduce patients’ disease burden; the combinations used often depend on the available drugs in the country of treatment. Oncologists in the United States often use a combination of bortezomib, lenalidomide, and dexamethasone for 4 cycles. Depending on an individual’s situation, other combinations may be used.

In this video, Dr Joseph Mikhael, hematologist and professor of medicine at the Mayo Clinic in Arizona, discusses the recent U.S. Food and Drug Administration (FDA) approval of daratumumab and the clinical implications for multiple myeloma treatment this approval may have. The recent approval, according to Dr Mikhael, is likely to have profound treatment implications for patients, as this drug may now be used earlier (for patients with fewer lines of therapy), and in combination with other therapies.

In this video, Dr Joseph Mikhael, hematologist and professor of medicine at the Mayo Clinic in Arizona, discusses treatment approaches for patients with multiple myeloma who relapse after receiving bortezomib, lenalidomide, and dexamethasone, transplant, and lenalidomide maintenance. Dr Mikhael recommends against using lenalidomide for patients who progress after lenalidomide therapy; he notes that daratumumab and bortezomib is an attractive option, though others are available. The treatment approach should vary in accordance with the aggressiveness of the disease.

In this video, Dr Joseph Mikhael, hematologist and professor of medicine at the Mayo Clinic in Arizona, discusses medication adherence in the treatment of multiple myeloma. Adherence is, relative to other cancers, a common problem in myeloma treatment, if only because more therapies are available for myeloma than for many other cancers. It’s important, according to Dr Mikhael, to carefully explain the importance of each agent to the patient. Close follow-up, especially within the first few months of initiating treatment, is also recommended.

In this video, Dr Joseph Mikhael, hematologist and professor of medicine at the Mayo Clinic in Arizona, discusses the treatment of elderly patients with myeloma. The average age of myeloma diagnosis is about 66 years; in this setting, “elderly” is often defined as “ineligible for transplant,” which is most common among those around 70 years or older. Dr Mikhael recommends against using upfront melphalan for these patients, as this agent’s effects on the bone marrow can preclude the possibility of other treatments being used. There shouldn’t be a “one size fits all” approach for older patients; treatments should be prescribed in accordance with a patient’s tolerance. Significant toxicity is possible if elderly patients are overtreated.

In this video, Dr Joseph Mikhael, hematologist and professor of medicine at the Mayo Clinic in Arizona, discusses the most promising emerging treatment for multiple myeloma. Proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and alkylator drugs are the 4 categories of therapies available to patients with myeloma. Each category has had multiple generations, and more are likely. Dr Mikhael notes that, in the future, oncologists will be able to move beyond these categories. Novel therapies such as selinexor, for example, can be active even in patients who received all other available therapies. Other treatments, such as antivirals and CAR T-cell therapies, are also promising.

In this video, Dr Joseph Mikhael, hematologist and professor of medicine at the Mayo Clinic in Arizona, discusses treatment resistance among patients with multiple myeloma. Understanding mechanisms of resistance, according to Dr Mikhael, is “critical.” Genetic and genomic work to individualize therapy will become increasingly important, a practice that is already being adopted in some clinics. Resistance must be understood in individuals, not only in populations.