ASCO 2019 | Discussion: Intensive treatment strategies: at what stage should these be deployed in SMM and NDMM?

During ASCO 2019, Chicago, US, the Multiple Myeloma Hub were delighted to speak to both Maria-Victoria Mateos and Francesca Gay about the use of intensive treatment strategies in smoldering multiple myeloma (SMM) and newly diagnosed multiple myeloma (NDMM). This is the first expert discussion the MM Hub have presented, on an important and prevalent topic in myeloma. This discussion centres around the available data and both speaker's expert opinions on how the different approaches may impact on clinical practice.

The following questions are addressed:

• Will carfilzomib + lenalidomide + dexamethasone (KRd) become a standard of care for NDMM?
• Should KRd be utilized in asymptomatic myeloma patients (high-risk SMM)?
  
• As the responses to KRd +/- autologous transplant are the same in asymptomatic high-risk SMM and NDMM, should we deploy these strategies earlier?
• How do we identify patients with high-risk SMM?
• Can this definition be implemented easily into clinical practice?
• Can we avoid over-treating patients?
• How could the KRd regimen be intensified for the treatment of NDMM?

Conclusion

Both experts agreed that intensive treatments are feasible for patients with NDMM and high-risk SMM, but this is only the starting point to personalizing therapy. The intensive treatment should be modified according to risk factors, ensuring a different, but appropriate treatment for each patient.