DR LOVE: Just to finish out here, can you bring us up to date on this man?

DR RAJE: After he got carfilzomib/pom/dex, he did well for about a year on the carfilzomib/pom/dex and then relapsed again. Again an aggressive relapse. And this time we switched out pom, put him back on len/dex and added daratumumab to the len/dex. So he is currently on daratumumab with len/dex. He’s actually had an incredible response to the addition of daratumumab to the IMiD and is doing really well. He’s achieved kind of a VGPR to this and continues on dara with len.

DR LOVE: And, again, just out of curiosity, how did he do with his first infusion of dara?

DR RAJE: The first infusion, he had kind of a scratchy throat, a cough. No shortness of breath or anything. He needed a little bit of steroids. We do slow the infusion, which is part of the reason why it takes longer than usual — he got it over 8 hours. But that was just the first infusion. After that, he has done well. I think he finishes his infusion in about 3 and a half hours every time now.

DR LOVE: You both have been talking about the CASTOR study that was dara/bortezomib/dex, originally presented as a plenary at ASCO, and then the POLLUX study looking at dara/len and dex that was also published in The New England Journal, presented at EHA. And then there was also a paper looking at dara with pom/dex at the ASH meeting. So maybe, Rafael, you can just take a shot at, globally, what we learned from these 3 studies, what you think it means.

DR FONSECA: I think what we’re learning from all the trials that are coming forward with daratumumab is that, one, it’s probably best done in combination. So as we have the original trials that were presented by Dr Plesner that looked at the 30% response rate in myeloma that was heavily pretreated, to where we are right now, we know that we can augment the responses by the combination of daratumumab.

We mentioned briefly it can be combined with proteasome inhibitors. I don’t think we’ve seen much with carfilzomib yet, but we’ve seen it with bortezomib. And certainly we’ve seen that with lenalidomide and with pomalidomide. The group from Emory is presenting data on daratumumab/pomalidomide and dexamethasone and, again, showing that it’s not only feasible, but it’s highly effective.

I’m just going to share in 10 seconds a case that I have of a patient I saw who had been through 3 lines of therapy prior to transplant, stem cell transplant. The patient was highly refractory, was in renal failure, on hemodialysis, with some attempts at plasma exchange. We saw the patient. We placed the patient on daratumumab/pomalidomide and dexamethasone, as we have discussed. We pushed with the plasma exchange. We prevented the permanent fistula to be placed in the patient’s arms for hemodialysis. So not only did he come off hemodialysis, but he has now completed his stem cell transplant and is soon going on to maintenance therapy.

Diagnosis and management of smoldering myeloma

Induction, consolidation and maintenance therapy for MM

Treatment of relapsed/refractory MM

Novel approaches under investigation for MM