2026 Cleveland PFS Slides - Saturday

WELCOME TO THE CLEVELAND PATIENT & FAMILY SEMINAR

SATURDAY, MAY 2, 2026

HEATHER COOPER ORTNER

PRESIDENT & CEO

SCAN THIS QR CODE FOR KEY IMF RESOURCES

Helpful Links to:

• Slides from Friday & Saturday Programming

• Evaluations for Friday & Saturday Programming

• SparkCures Search Engine specific for the Ohio region

• Ways to Give

MORNING AGENDA

9:00 – 9:15AM Welcome & Announcements

9:15 – 9:45AM President & CEO Address

9:45 – 10:30AM Fireside Chat: What is the Future of Myeloma? With Q&A

10:30 – 10:45AM BREAK

10:45 – 11:45 AM Breakout Sessions #1: Treating Myeloma

Breakout A: Newly Diagnosed: Frontline Therapy

Breakout B: Managing Relapsed Myeloma

11:45 - 12:45PM LUNCH

AFTERNOON

AGENDA

12:45 – 1:30PM Find Your Path: Navigating Your Myeloma Journey

1:30 – 1:45PM Closing the Gap: Health Disparities in Myeloma

1:45 – 2:45PM

Breakout Sessions #2: Patients and Care Partners

Breakout A: Patients Only – Lessons Learned

Breakout B: Care Partners Only

2:45 – 2:50PM RETURN TO MAIN SESSION

Grab-and-Go Refreshments

2:50 – 3:20PM Controversies in Myeloma

3:20 – 3:55PM

Ask the Experts with Guest Faculty

OUR MISSION

Improving the quality of life of myeloma patients while working toward prevention & a cure

IMF LEADS THE WAY

Together, we are turning hope into action: one meeting, one conversation, one connection at a time.

Shared Experiences Become Shared Strength!

Support Groups empower patients & care partners with information, insight & hope

The IMF provides educational support to a network of over 155 myeloma specific groups and over 200 Group Visits/Year

MEET THE SUPPORT GROUP TEAM!

Cecilia

Our Commitment

The IMF Support Group Team offers an unmatched depth of clinical knowledge, personal insight, and supportive care.

We don’t just serve the myeloma community— we are part of it. We are united in our passion: to ensure that no one faces myeloma alone.

LOCAL SUPPORT GROUPS

• Cleveland, OH

• Cincinnati, OH

• Columbus, OH

• Youngstown, OH

• Canton, OH

• Cleveland Clinic

• Pittsburgh, PA

SPECIAL INTEREST GROUPS

MM Families

For patients & care partners with young children

Living Solo & Strong

For patients without a care partner

Veterans SIG

For those who served our country MM in the Middle

For those diagnosed before age 50

MM in the Middle

For those diagnosed before age 50

Care Partners Only

For myeloma care partners only

Smolder Bolder

For smoldering myeloma patients & care partners

Living with High-Risk Multiple Myeloma

For high-risk myeloma patients & care partners

MYELO

• Understanding lab results, terminology and disease state

• Preparing for medical visits

• Access to medical providers, specialty care (ASCT, CAR T)

• Access to specialty medications

• Financial resources

CLINICAL TRIAL MATCHING ENGINE

2026 PATIENT EDUCATION - US

Patient & Family Seminars

• Boca Raton, FL – March 13 – 14

• Cleveland, OH – May 1 – 2

• Los Angeles, CA – August 14 – 15

• Short Hills, NJ – October 2 – 3

Myeloma Community Workshops

• Kansas City, MO – March 28

• Virtual – April 20 – Newly Diagnosed

• Minneapolis, MN – April 25

• Detroit, MI – June 27

• Salt Lake City, UT – August 1

• Virtual – August 24 - Relapsed

Portland, OR – September 19

San Diego, CA – October 24

Phoenix, AZ – November 14

Virtual – November 16 -

EDUCATION – AWARENESS - MAM

11.8 K Mentions

60M Reach

346.5K Interactions

EDUCATION – VIDEO

EDUCATION – WRITTEN

IMF Research Leadership

Coordinated international leadership advancing prevention, better treatments, and a cure for myeloma

IMF Advances Global Myeloma Research

The Scientific Advisory Board (SAB) provides strategic scientific guidance and identifies emerging research priorities

The SAB helps shape and oversee major IMF research initiatives

The International Myeloma Working Group (IMWG), a global network of more than 300 myeloma researchers, collaborates to develop consensus guidelines, research standards, and landmark publications

The Black Swan Research Initiative (BSRI) drives innovative research aimed at achieving a cure for myeloma

Together, these programs foster global collaboration and accelerate scientific discovery

You are NOT Alone

THANK YOU!

Fireside Chat: What is the Future of Myeloma? With Q&A

Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO

IMF Medical

Advisor

Ashley Rosko, MD

Ohio State University Comprehensive Cancer Center, Columbus, OH

BREAK

WHEN YOU RETURN FROM BREAK, PLEASE HEAD TO YOUR

SELECTED BREAKOUT SESSION:

BREAKOUT A: NEWLY DIAGNOSED: FRONTLINE THERAPY

Please move to the Severance Room (4th Floor)

BREAKOUT B: MANAGING RELAPSED MYELOMA

Please remain in this room

SCAN THIS QR CODE FOR KEY IMF RESOURCES

Helpful Links to:

• Slides from Friday & Saturday Programming

• Evaluations for Friday & Saturday Programming

• SparkCures Search Engine specific for the Ohio region

• Ways to Give

Breakout B: Managing Relapsed Myeloma

Objectives

1. Discuss WHY relapses occur

2. Review important principles of selecting treatment for relapsed myeloma

3. Empower patents to engage in the decision-making process

4. Encourage patients to know there are MANY options for relapsed myeloma

Myeloma almost always Relapses

SYMPTOMATIC REFRACTORY RELAPSE

Adapted from Dr. Brian Durie and Keats JJ, et al. Blood. 2012;120:1067-1076.

Why does Myeloma Relapse?

We speculate many reasons for this...

1. It is never fully cleared

Minimal Residual Disease (MRD) negativity is not truly NEGATIVE

2. The immune system cannot contain or prevent the disease Remember myeloma is a disease of the plasma cell

Many Treatment Options at Relapse

Myeloma Therapies Common Combinations

Belantamab mafodotinb Bela, BVd, BPd, BKRd

Bortezomib (SQ admin) VRd, Vd, VCd

Carfilzomib KRd, Kd, Dara-Kd, Isa-Kd

Ciltacabtagene Autoleucel Cilta-Cel

Daratumumab Dara-Rd, Dara-Vd, Dara-Pd, Dara-VMp, Dara-Kd

Elotuzumab ERd, EPda

Idecabtagene Vicleucela Ide-Cel

Isatuximab Isa-Pda, Isa-Kd

Ixazomib IRd

Lenalidomide VRd, Rd, KRd, Dara-Rd, ERd, IRd

Pomalidomidea Pda, Dara-Pd, EPda, PCdb

Selinexor Xd, XVd, XKdb, Dara-Xdb

Teclistamab, Talquetamab, Elranatamab, Linvoseltamab

Many treatment options are available.

More therapies are being studied Clinical trials may be an option

Teclistamab and Daratumumab

New agents or regimens in clinical trials are always an option

1. Change current mechanism of action

Key – when myeloma relapses, it “overcomes” the current therapy being used, so it is necessary to change the approach to the disease with a new a mechanism of action

Drug Class Overview

IMiD

Proteasome

drug Thalomid (thalidomide)

Revlimid (lenalidomide)

(pomalidomide)

(carfilzomib)

Rev, Len

Darzalex (daratumumab)

Sarclisa (isatuximab)

(elotuzumab)

Drug Class Overview

Peptide Drug Conjugate* Pepaxto (Melphalan Flufenamide)

BCMA Targeted Antibody Drug Conjugate (ADC)

Blenrep (belantamab mafodotinblmf) Bela, Belamaf, or B

Abecma (idecabtagene vicleucel)

Bispecific Antibodies

Carvykti (ciltacabtagene vicleucel)

Tecvayli (teclistimab)

Talvey (Talquetamab)

Elrexfio (Elranatamab)

Lynozyfic (Linvoseltamab Tec Talq Elra Linvo

Cevostamab, Iberdomide, Mezigdomide, Anito-cel, Venetoclax

AZD0120, Etentamig, KLN-1010, Trispecifics ……………………………

* This agents is currently off the market in the US but available through special programs

SC or SQ = Subcutaneous, Under the skin; IV = Intravenous

2. Don’t Save the Best for Last!

Typically the most durable remissions occur earlier in the disease course

So, we want to use the best possible therapies before the disease becomes more resistant

Therapies tend to have a greater effect earlier in the disease course...

3. Typically use CAR-T Cell Therapy, Bispecific Antibodies or Triplets

As will be discussed today, options for relapsed myeloma have grown and these three approaches have the best outcomes

This has to be balanced with patient characteristics and preferences – so other options (like doublets) can be considered

NEW – the combination of Teclistamab and Daratumumab was approved in March 2026

4-6. Consider Patient, Disease and Treatment Factors

• Nature of relapse

• Renal insufficiency

• Hepatic impairment

• Comorbidities

• Preferences

• Social factors

– Support system

– Accessibility to treatment center

– Insurance coverage

• Previous therapies

• Prior treatment-related adverse event(s)

Disease Treatment Patient

– Biochemical vs symptomatic

• Risk stratification

– High-risk chromosomal abnormalities: del(17p), t(4;14), t(14;16)

• Disease burden

• Regimen-related toxicity

• Depth and duration of previous response

7. Depth of Response Matters

MRD refers to the persistence of residual tumor cells after treatment and is responsible for relapse1

MR→PR→ VGPR→CR →sCR

1. Adapted from Hauwel M, Matthes T. Swiss Med Wkly 2014:144:w13907 2. Biran N, et al. Curr Hematol Malig Rep 2014;9:368–78

Current techniques can detect MRD with a sensitivity of 10-6 for MM cells2

Measuring Disease Response: IMWG Response Criteria

Negative by next generation flow (NGF) (minimum sensitivity 1 in 10-5 nucleated cells or higher)*

mCR AND normal Free Light Chain ratio, Bone Marrow negative by flow, 2 measures

CR AND negative PCR

Complete Response: Negative immunofixation (IFE); no more than 5% plasma cells in BM; 2 measures

Very Good Partial Response: 90% reduction in myeloma protein

Partial Response: at least 50% reduction in myeloma protein

Minimal Response

Stable Disease: Not meeting above criteria

Progressive Disease: At least 25% increase in identified myeloma protein from lowest level

MRD = Minimal Residual Disease sCR = Stringent Complete Response; BM = Bone Marrow

8. Sequencing is Important but not fully

Known

We are still learning what is the “optimal” sequence of therapies but it is clear there is no “optimal” sequence as so many variables influence choice

But a few lessons are being learned:

1. In general if a patient is CAR T eligible, it is preferred prior to bispecific antibodies

2. All therapies can be sequenced in any order but it can reduce its efficacy – T cells in particular may need a ”rest”

9. Always include a Quality of Life Discussion

We do not treat myeloma, but PEOPLE! How it affects your life and your preferences is critical and should be considered...

10. Use the Shared Decision Making Model

“The aim of shared decision making is to ensure that: - Patients understand their options and the pros and cons of those options.

- Patient's are used to guide decisions.”

The Evolution of Myeloma Therapy

VD

Rev/Dex

CyBorD

VTD

VRD KRD

D-VMP

DRD

Tandem ASCT (?)

Nothing

Thalidomide?

Bortezomib

Ixazomib

Lenalidomide

Combinations

D-VRD

Isa-VRD

D-KRD

Isa-VRD “More” induction?

Bortezomib

Lenalidomide

Carfilzomib

Pomalidomide

Selinexor

Panobinostat

Daratumumab

Ixazomib

Elotuzumab

Isatuximab

Belantamab mafodotin*

Melphalan flufenamide*

Idecabtagene autoleucel

Ciltacabtagene autoleucel

Teclistamab, Talquetamab

Elranatamab, Linvoseltamab

Daratumumab?

Carfilzomib?

Lenalidomide + PI

ASCT, autologous stem cell transplant; CAR, chimeric antigen receptor; Cy, cyclophosphamide; d- daratumumab; D/dex, dexamethasone; isa, isatuximab; K, carfilzomib; M, melphalan; PD-L1, programmed death ligand-1; PI, proteasome inhibitor; Rev, lenalidomide; V, bortezomib.

Speaker’s own opinions.

CAR T Cell Therapy

Bispecific/Tri-specific

Antibodies

Cell Modifying Agents

Venetoclax

PD/PDL-1 Inhibition?

Small Molecules

* These agents are currently off the market but available through special programs

Anito-cel

Cevostomab

Iberdomide, Mezigdomide

Sonrotoclax

KLN-1010

AZD0120

SCAN THIS QR CODE FOR KEY IMF RESOURCES

Helpful Links to:

• Slides from Friday & Saturday Programming

• Evaluations for Friday & Saturday Programming

• SparkCures Search Engine specific for the Ohio region

• Ways to Give

LUNCH

Please move to the Erie Room

Find Your Path: Navigating Your Myeloma Journey

IMF Nurse Leadership Board

Beth Faiman, PhD, MSN, APN-BC, AOCN®, BMTCN®, FAAN, FAPO

Cleveland

Clinic Taussig Cancer Institute, Cleveland, OH

Find Your Path: Navigating Myeloma

Beth Faiman PhD, MSN, APN-BC, AOCN®, TCTCN®, FAAN, FAPO

Cleveland Clinic Taussig Cancer Institute

Cleveland, OH

Myeloma’s Terrain: Finding Your Footing

Myeloma Is a Cancer of the Plasma Cells

Myeloma’ s

Terrain

In Multiple Myeloma, one plasma cell mutates, making many identical plasma cells (monoclonal).

Plasma

Cells come from white blood cells produced in the bone marrow and make many different antibodies to help fight infection (polyclonal).

Myeloma Causes Cell Dysfunction & Symptoms

Myeloma’

Terrain

Bone marrow

Anxiety Stress Depression

Decreased red blood cells

Anemia & Fatigue

Decreased white blood cells

Myeloma protein in blood and urine

Changes in bone remodeling

Clonal myeloma plasma cells can cause many issues

• Crowd out normal bone marrow cells

• Can cause kidney dysfunction

• Affect bone cells (balance of osteoclasts & osteoblasts)

Immune Dysfunction & Infection

Renal Dysfunction

Bone Damage

Infections Are Serious for People with Myeloma

Preventing infections is paramount.

IMWG

Infection remains the leading cause of death in patients with multiple myeloma. Several factors account for this infection risk, including the overall state of immunosuppression from multiple myeloma, treatment, age, and comorbidities (e.g., renal failure and frailty).

Report fever of more than 100.4°F, shaking chills even without fever, dizziness, shortness of breath, low blood pressure to HCP as directed.

IMWG Consensus guidelines and recommendations for infection prevention in multiple myeloma; Lancet Haematol.2022;9(2):143–161.

Infection Prevention Tips

Good personal hygiene (skin, oral)

Environmental control (avoid crowds and sick people; use a high-quality mask when close contact is unavoidable)

As recommended by your healthcare team:

Immunizations:

Flu, COVID, RSV & and pneumococcal vaccinations; avoid live vaccines

Preventative and/or supportive medications

Kidney and Bone Health

Protect Kidney Function

Myeloma Treatment

Stay hydrated--drink water

Avoid certain medications

• IV contrast dyes

Protect Bone Health

• Myeloma Treatment

• Nutrition

• Vitamin D

• Calcium (if approved by doctor)

• NSAIDs like Advil (ibuprofen), Aleve (naproxen)

Be alert: symptoms of kidney dysfunction

• Fatigue and weakness

• Nausea and vomiting

• Foamy or dark urine

• Swelling in feet, ankles, or face

• Shortness of breath

• Persistent itching

• Loss of appetite

• Muscle cramps

• High blood pressure

• Weight-bearing activity (e.g., walking, standing, climbing stairs, stretching, dancing)

• Bone-strengthening agents (prescribed by your healthcare team)

Easing the Way: Pain Management

Pain can significantly compromise quality of life and add to distress.

Sources of pain include bone disease, neuropathy and medical procedures.

Prevention

• Decrease fracture risk through myeloma treatment, bone strengthening agents, physical activity, preventative surgery

• Prevent Nerve Damage: prevent shingles, manage diabetes, myeloma medication dosing and route of administration

• Combine scheduled medical procedures, when possible (Ex. blood draw, biopsy), use sedation if available

Treatment

Interventions depend on source of pain, may include

• Medications, Surgery, Radiation therapy, etc.

• Physical therapy & continued activity, complementary therapies (Mind-body, meditation, yoga, supplements, acupuncture, etc.)

• Scrambler therapy for neuropathy

Discuss with your healthcare provider new bone pain or chronic pain that is not well controlled and decreasing pain medication if pain has improved.

Starting Your Trek: Initial Treatment

Starting Your Trek: Initial Treatment

Charting the Course of Myeloma

HR-SMM = high risk smoldering multiple myeloma; M-protein = monoclonal protein; MGUS = monoclonal gammopathy of undetermined significance; misc = miscellaneous (no dominant clone); MM = multiple myeloma; SMM = smoldering multiple myeloma.

Adapted from Durie B. Keats JJ, et al. Blood. 2012;120(5):1067-1076.

Why Shared Decision Making in Multiple Myeloma?

The relapsing nature of multiple myeloma means patients and their care partners may have multiple points to make decisions about treatment & care

People with myeloma are living longer; goals, preferences, and values may change over time

“The aim of shared decisionmaking is to ensure that:

- Patients understand their options and the pros and cons of those options.

- Patient's goals and treatment preferences are used to guide decisions.”

Patient and Care Partner Roles in Shared Decision Making – Come Prepared

Ask questions (write them down in advance of visit)

• What are my treatment options?

• What are the pros and cons of each option? Efficacy? Side effects? Administration? Insurance nuances?

• Are there treatments that wouldn’t be a good option for me? Why?

Express your desire to participate in the treatment decisions

• I want to make sure the treatment we chose is the best option for me

• I want to be sure we are choosing the best therapy for my husband/wife

Ask for time (if needed/ appropriate)

• There is a lot to think about. Can I/we have some time to consider the options?

• Ask for information you can consider at home

• Note: if medical emergency/high risk, may not be appropriate

Patient and Care Partner Roles in Shared Decision Making

Starting Your Trek

Understand options; consider priorities

Express your goals/values/preferences; create a dialog

Arrive at a treatment decision together

• Use reliable sources of information like the IMF and “Myelo”

• Use caution when considering stories of personal experiences

• Consider your goals, values and preferences

• My top priority is [goal/value]; additional [preferences] are also important.

• I think [treatment] may be a good choice given my priorities… What do you think?

• What treatment would you recommend given my goals and priorities?

IMF Has Resources to Help You Be A Part of Your Treatment Decisions

• Be empowered to be part of decision-making

• Stay informed, understand options

• Use reliable and current sources of information

• Use caution considering stories of personal experiences

• Consider your priorities

• Discuss with your care partner

• Consider your goals/values/preferences

• Be a part of the conversation, create a dialog

• Ask questions & Express your goals/values/preferences

• Ask for time to consider options, if needed

• Arrive at a treatment decision together

• Arrange follow up to review and adjust, if needed

New Directions: Treatment for High-Risk Smoldering

High-Risk SMM

High potential to progress to active MM in 2 years

• M-spike ≥ 2 g/dL

• Free light chain assay (involved/uninvolved ratio ≥ 20)

• Bone marrow ≥ 20% clonal plasma cells

FDA approved Nov2025

Multiple Myeloma (HR-SMM)

51% Reduction in risk of disease progression or death with Darzalex Faspro® treatment of high-risk SMM (compared with active monitoring)

DARZALEX FASPRO® as monotherapy is indicated for the treatment of adult patients with high-risk smoldering multiple myeloma

FDA = US Food and Drug Administration; MM = multiple myeloma; SMM = smoldering multiple myeloma

Dimopoulous MA, et al. N Engl J Med. 2024;394(18):1777-1788. doi: 10.1056/NEJMoa2409029. Mateos, MV, et al. Blood Cancer J. 2020;10:102. (2020). https://doi.org/10.1038/s41408-020-00366-3 Use

Treatment of Newly Diagnosed Multiple Myeloma (NDMM)

Induction

Consolidation

Initial treatments aimed at reducing the amount of myeloma cells

Intensification of treatment to deepen response. Either additional cycles of induction or autologous stem cell transplant (in eligible patients)

Prolonged lower-intensity treatment designed to sustain remission Maintenance

Induction Standard of Care

Starting

Your Trek

Quadruplet therapy is preferred for nearly all patients with newly diagnosed myeloma

1 2 3 4

Anti-CD38

Monoclonal Antibody (mAb)

• Darzalex (daratumumab)

• Sarclisa (isatuximab)

Proteosome Inhibitor (PI)

• Velcade (bortezomib)

Immunomodulatory Drug (IMiD)

• Revlimid (lenalidomide)

• Kyprolis (carfilzomib) Steroids

• Pomalyst (pomalidomide)

At infusion clinic: subcutaneous injection, on body device or infusion

Supportive medication:

• Decadron (dexamethasone)

• Prednisone

Oral medication taken at home

• Antiviral prophylaxis (i.e., acyclovir or valacyclovir) to prevent viral infections, particularly shingles.

• Antibacterial agents (i.e., Bactrim, levofloxacin) to prevent bacterial infections.

• Aspirin or other anticoagulant therapy to reduce the risk of blood clots from IMiDs.

• Bone-strengthening agents (i.e., zoledronic acid, denosumab) to strengthen bones and protect against fractures.

Steroids: Part Of The Treatment Plan

Steroids enhance the effectiveness of other myeloma therapies

Your provider may decrease or discontinue the dose as myeloma responds to therapy.

Do not stop or alter your dose of steroids without discussing it with your provider

Possible Steroid Side Effects

• Irritability, mood swings, depression

• Difficulty sleeping (insomnia), fatigue

• Blurred vision, cataracts

• Increased risk of infections, heart disease

• Muscle weakness, cramping

• Increased blood pressure, water retention

• Flushing/sweating

• Stomach bloating, hiccups, heartburn, ulcers, or gas

• Weight gain, hair thinning/loss, skin rashes

• Increased blood sugar levels, diabetes

Managing Steroid Side Effects

• Consistent schedule (AM vs. PM)

• Take with food

• Stomach discomfort: Overthe-counter or prescription medications

• Medications to prevent shingles, thrush, or other infections

Rajkumar SV, et al. Lancet Oncol 11(1):29–37. King T, Faiman B. Clin J Oncol Nurs. 2017;21(2):240-249. Banerjee,R. et al. Blood 9.25.24

Peripheral Neuropathy

Peripheral neuropathy happens when there is damage to nerves in the extremities (hands, feet, limbs). Damage can be the result of myeloma, treatment or unrelated conditions (i.e., diabetes).

Symptoms:

Numbness

Tingling

Prickling sensations

Sensitivity to touch

Burning and/or cold

sensation

Muscle weakness

Prevention / management:

Bortezomib once-weekly and/or subcutaneous administration

Massage area with cocoa butter regularly

Neuroprotective Supplements

• i.e., B-complex vitamins (B1, B6, B12)

Safe environment: rugs, furnishings, shoes

If neuropathy worsens, your provider may:

Adjust your treatment plan

Prescribe oral or topical pain medication

Suggest physical therapy

Blood Clots: Managing DVT and PE Risk

Starting Your Trek

HCPs may manage DVT/PE risk by

• Adjusting medications and schedules

Blood clots can cause swelling, pain, discoloration (DVT), shortness of breath, chest pain, sense of doom (PE). Blood clots are serious and can be life threatening.

• Prescribing blood-thinning medications according to assessed risk (DOAC, aspirin, warfarin, heparin)

• Balancing the risk of DVT and PE with that of bleeding with low platelets

Additional strategies to reduce risk of clots:

• Anti-embolism stockings (elastic stockings)

• Exercise regimen

• Moving frequently when sitting long periods

• Travel precautions (foot/leg exercises, walking, aspirin if not already on blood thinner)

You may be at risk:

• Family History • Obesity • Immobility • Smoking • Surgery

DOAC = direct oral anticoagulant; HCP = health care provider; DVT=deep vein thrombosis; PE=pulmonary embolism

Rome, S, et al. Clin J Oncol Nurs. 2008;12(3)suppl:37-52. Faiman B. Clin J Oncol Nurs. 2016;20(4):E100-E105. De Stefano, et al. Hematologica, 2022

Stem Cell Transplant

ELGIBILITY

Your Trek

Location: Transplant Center P H A S E 1

Measuring treatment response

Testing for Eligibility

Insurance authorization Collecting stem cells

Duration: Approximately 2 weeks

P H A S E 2

TRANSPLANT

HD-Melphalan Stem cell infusion Supportive Care

• GI Management

• Transfusions

• Antibiotics

Hair Loss Engraftment

Duration: Approx. 3-4 weeks Location: Transplant Center

Location: HOME P H A S E 3

Restrengthening Appetite recovery

“Day 100” assessment

Begin maintenance therapy

Duration: Approximately 1012 weeks

Stem cell transplant after induction remains the standard of care for eligible patients

GI Symptoms: Prevention & Management

Fluid intake can help with both diarrhea and constipation and helps kidney function

Constipation is more common in the induction phase

Opioid pain relievers, antidepressants, heart or blood pressure medications (check with provider, pharmacist)

Supplements: Calcium, Iron, vitamin D (rarely), vitamin B-12 deficiency

Increase fiber

Stay well hydrated

Fruits, vegetables, high fiber whole grain foods

Fiber binding agents – Metamucil® ,

Citrucel®, Benefiber®

Anorexia, the inability to eat, is common during transplant and resolves with time.

• Hydration is most important

• Small, frequent meals with a focus on protein intake

• You will work closely with a dietician to help monitor your calorie intake

Diarrhea is common during transplant and long-term maintenance therapy.

Other medications and supplements can cause GI issues.

Hydration is very important

Electrolyte replacement is common

Good skin care will help prevent irritation

Stool exam may be needed to rule-out infection

If no infection, anti-diarrheal medication may be prescribed

Discuss GI issues with healthcare providers to identify causes and adjust medications and supplements

Changing Course: Treatment at Relapse

Treatment Options at Relapse

Changing Course

Myeloma Therapy

Common Combinations or Therapy Names

Belantamab mafodotina BVd, BPd, BKRd

Bortezomib (SQ admin)

Carfilzomib

Car T-cell

Daratumumab

Elotuzumab

VRd, Vd, VCd

KRd, Kd, Dara-Kd, Isa-Kd

Cilta-Cel®, Ide-Cel®

Dara-Rd, Dara-Vd, Dara-Pd, Dara-VMp, Dara-Kd, Dara-Tecvayli®

ERd, EPda

Isatuximab Isa-Pda, Isa-Kd

Ixazomib IRd

Lenalidomide

VRd, Rd, KRd, Dara-Rd, ERd, IRd

Pomalidomidea Pda, Dara-Pd, EPda, PCdc

Selinexor

Xd, XVd, XKdc, Dara-Xdc

T cell Engager (Bispecific)b Elrexfio®, Lynozyfic™, Talvey®, Tecvayli

New agents or regimens in clinical trials may be an option

Many therapy options are in the myeloma toolkit and more are being studied

a2 or more prior therapies. b4 or more prior therapies. cOff-label; not currently FDA-approved.

C = cyclophosphamide; d = dexamethasone; Dara = daratumumab; FDA = US Food and Drug Administration; E = elotuzumab; Isa = isatuximab; I = ixazomib; K = carfilzomib; M = melphalan; p = prednisone; P = pomalidomide;

R = lenalidomide; SQ = subcutaneous; V = bortezomib; X = selinexor.

NCCN Guidelines®. Multiple Myeloma V4.2026. Accessed December 22, 2025.

CAR T-Cell Therapy T-Cell Engager (TCE) Therapy

Relapsed MM after 4 prior LOT (or clinical trials)

Relapsed MM with 1-2 prior LOT

Changing Course

BCMA target: potential for infection

• Abecma® (ide-cel)

• Carvykti® (cilta-cel)

• (anito-cel – pending FDA approval)

TCE are innovative immunotherapies used in the treatment of relapsed multiple myeloma. These therapies work by redirecting the patient's own T-cells to recognize and attack myeloma cells.

Bridging therapy, if needed; Lymphodepleting therapy when CAR T cells are ready T Cell Infusion Close monitoring and Management of side effects 1 3 4 5 HOME! Apheresis to Collect T Cells T Cell Manufacturing 2a 2b

Bispecific antibodies

• About 7 in 10 patients respond

• Off-the-shelf treatment; no waiting for engineering cells

BCMA target: potential for infection

• Tecvayli® (teclistamab)

• Elrexfio® (elranatamab)

• Lynozyfic™ (linvoseltamab)

Cytotoxic cytokines

Bispecific antibody T cell MM cell

GPRC5D target: potential for skin and nail side effects, GI issues of taste change, anorexia and weight loss

• Talvey® (talquetamab)

FcRH5 target: new myeloma target

• (cevostamab - pending FDA approval)

Target CD3

BCMA = B-cell maturation antigen; CAR = chimeric antigen receptor; GPRC5D = G protein–coupled receptor, class C, group 5, member D; CAR = Chimeric Antigen Receptor; LOT = Lines of Therapy; MM = multiple myeloma.

Shah N, et al. Leukemia. 2020;34(4):985-1005.

CAR T and Bispecific Antibodies: Known Side Effects

Changing Course

CYTOKINE RELEASE SYNDROME (CRS) ICANS AND NEUROTOXICITY

• Fever

• Fatigue & Weakness

• Headache

• Nausea/Vomiting/Diarrhea

• Chills

• Low blood pressure

• Rapid heart rate

• Difficulty breathing

CRS is a common but typically mild & manageable side effect

PREVENTION AND MANAGEMENT of CRS

• Disease management to reduce tumor burden

• Bispecific Step-up Dosing (SUD)

• Tocilizumab

• Steroids

• Anti-Seizure medications

• Close monitoring

• Headache

• Difficulty concentrating

• Lethargy

• Agitation

• Hallucinations

• Tremors

• Confusion

• Memory loss

• Aphasia (difficulty with speech, reading, writing, or understanding language)

• Personality change

• Delayed Neurotoxicity can include Parkinsonism, Cranial Nerve Palsies and Peripheral Neuropathy/Guillan Barré syndrome (GBS)

CAR = chimeric antigen receptor. ICANS = Immune Effector Cell-Associated Neurotoxicity Syndrome

Brudno JN, Kochenderfer JN. Blood. 2016;127(26):3321-3330. Lee DW, et al. Biol Blood Marrow Transplant. 2019;25:625-638. Kumar, et al.

Blood (2024) 144 (Supplement 1): 4758.

Infection: Medications Can Reduce Risk

Changing Course

Type of Infection Risk

Medication Recommendation(s) for Healthcare Team Consideration

Viral: Herpes Simplex (HSV/VZV); CMV Acyclovir prophylaxis

Bacterial: blood, pneumonia, and urinary tract infection

PJP (P. jirovecii pneumonia)

Fungal infections

COVID-19 and Influenza

IgG < 400 mg/dL (general infection risk)

ANC < 1000 cells/μL (general infection risk)

Consider prophylaxis with levofloxacin

Consider prophylaxis with trimethoprim-sulfamethoxazole (Bactrim)

Consider prophylaxis with fluconazole

Antiviral therapy if exposed or positive for covid per institution recommendations

IVIg recommended for patients receiving CAR T or TCE therapies

Consider G-CSF 2 or 3 times/wk (or as frequently as needed) to maintain ANC > 1000 cells/μL and maintain treatment dose intensity

Some people receiving BCMA-targeting therapies have experienced infections that are less common like CMV, PJP and fungal infections

ANC = absolute neutrophil count; BCMA = B-cell maturation antigen; CAR = chimeric antigen receptor; CMV, cytomegalovirus; GCSF = granulocyte colony-stimulating factor; HSV = herpes simplex virus; IVIg = intravenous immunoglobulin;

PJP = Pneumocystis jirovecii pneumonia; VZV = varicella zoster virus. Raje NS, et al. Lancet Haematol.2022;9(2):143–161.

Management of Oral Side Effects

Changing Course

Xerostomia

OTC dry mouth rinse, gel, spray are recommended. Avoid hot beverages. Anti-fungal therapy for oral thrush.

Dysgeusi a Dexamethasone oral solutions “swish and spit” may provide benefit. Sour citrus or candies before meals are also recommended.

Dysphagia

= Dry Mouth = Difficulty Swallowing = Taste Change

Dental Care

Attention to oral hygiene. Regular dental cleaning and evaluation. Close monitoring for ONJ, oral cancer and dental caries

Dietary modifications with small bites, eating upright, and sips with food can help manage symptoms

Weight Monitoring

Some medications lead to weight gain, others to weight loss. Meet with a nutritionist

Consider diet changes, supplements

Work closely with your entire health care team to manage oral side effects.

ONJ = Osteonecrosis of the Jaw; OTC = Over The Counter

Management of Skin and Nail Side Effects

Possible side effect to some treatments and supportive care medications

Skin Rash

Prevent dry skin; apply lotion

Report changes to your care team

Medication interruption or alternative, as needed

Steroids:

• Topical for grades 1-2,

• Systemic and topical for Grade 3

Anti-histamines, as needed

Nail Changes

Keep your nails short and clean.

Watch for “catching and tearing”

Apply a heavy moisturizer like Vaseline or salve. Wear cotton hand coverings to bed

A nail hardener may help with thinning

Tell the team if you have signs of a fungal infection, like thickened or discolored nails

Fatigue, Anxiety and Depression

Symptoms are under-reported:

“I mentioned it before. Nothing can be done.”

“I don’t want to be put on another medication.”

Fatigue is the most reported symptom. Sources include anemia, pain, reduced activity, insomnia, treatment toxicity, bone marrow suppression. Symptoms can improve with continued physical activity

Healthy Practices to Sustain Your Trek

Adopt Healthy Behaviors

• Mental health / social engagement

• Stress reduction; relaxation

• Sufficient Sleep

Recommended Health Screenings

 Blood pressure

 Cholesterol

 Cardiovascular disease

• Maintain a healthy weight; eat nutritiously

• Activity / exercise / prevent falls, injury

• Stop smoking

• Sexual health / intimacy

• Complementary or alternative therapy

• Socializing, Staying connected

Have a PCP for general check ups, preventative care, health screenings, vaccinations

Have specialists for dental care, eye exams/screening, skin cancer screening

 Colonoscopy

 Dental checkups & cleaning  Dermatologic evaluation

Diabetes

Hepatitis

Hearing

Vision  Women specific: mammogram, pap smear  Men specific: prostate

Faiman B, et al. CJON. 2017;21(5)suppl:19-36. Dimopoulous M, et al. Leukemia. 2009;23(9):1545-56.

Brigle K, et al. CJON. 2017;21(5)suppl:60-76. Faiman B, et al. CJON. 2017;21(5)suppl:19-36. Faiman B, et al. CJON. 2011;15suppl:66-76. Miceli TS, et al. CJON. 2011;15(4)suppl:9-23.

Don’t Hike Alone: Care Partners

Multiple studies demonstrate that strong social ties are associated with

• Increased longevity, including people with cancer

Caring for the care partner

• Recognize that caregiving is difficult and stressful

• Improved adherence to medical treatment leading to improved health outcomes

• Lower risk of cardiovascular diseases

• Increased sense of purpose & life satisfaction

• Improved mood and happiness

• Reduced stress and anxiety

• Enhanced resilience

Care partners may help with medical appointments, managing medication, daily living, physical assistance, emotional support, myeloma knowledge, healthy lifestyle, patient advocacy, financial decisions

Care partners can be a spouse, close relative, a network of people (family, friends, neighbors, church members, etc)

• Encourage care partners to maintain their health, interests, and friendships

• The IMF has information and resources to help care partners

Tip Cards

“THANK YOU!”

Closing the Gap: Health Disparities in Myeloma

Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO IMF Medical Advisor

What are Health Disparities

Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations

- Centers for Disease Control (CDC)

Health equity generally refers to individuals achieving their highest level of health through the elimination of disparities in health and health care

A Call to Action Facts About Disparities in Myeloma

M-Power = Myeloma Power

The core vision of this initiative is to improve the short- and long-term outcomes for African American patients with myeloma.

We want to empower patients and communities to change the course of myeloma…

Enhance access to optimal care by educating myeloma providers about the disparity and how to reduce it

Engage the community to increase awareness and provide support

Shorten the time to diagnosis by educating primary care providers to recognize the disease and order the right tests

M-Power Is Both a National and Local Movement

Juneteenth 2025: New York City

MULTIPLE MYELOMA DIAGNOSIS CAN BE CHALLENGING

Kyle RA. Mayo Clin Proc. 2003;78:21-33.

DIFFERENT SPECIALISTS SEE AND DIAGNOSE MULTIPLE MYELOMA PATIENTS

Other Physician

Emergency Care

Hematologist

Oncologist

Primary Care/ Internal Medicine

Nephrologist

Orthopedic

Rheumatologi st Neurologist

Typical diagnostic intervals1

Hematology/Oncology: < 3 months

Primary Care: > 6 months

The average patient will see their PCP THREE times with signs and symptoms of MM before the diagnosis is suspected!2

1. Kariyawasan CC, et al. QJM. 2007;100:635-640. 2. Hossain M, et al. An in depth analysis of factors contributing to diagnostic delay in myeloma: a retrospective UK study of patients journey from primary care to specialist secondary care. Blood. 2021;138(suppl 1):3007.

Education of Primary Care Providers

Our goal is to reduce DELAYS in diagnosis among African Americans by educating the primary care community with a focus on:

• Recognizing the signs and symptoms of myeloma

• Discriminating myeloma from other diagnoses such as diabetes

• Capturing an accurate diagnosis through proper use of testing

• Providing referral guidelines for Hematology and Oncology

• Grand Rounds

8,000

• Postcards mailed to 6,000+ PCPs in target cities

• Free PCP CME course “Don’t Miss Myeloma”

• Cobb Institute talk

• Talk at NMA Annual Meeting Dinner Meetings Articles and pending publications

3rd Annual Medical Student Scholars Program

• 11 1st through 3rd year medical students from all over the country met in Chicago on July 21st at the NMA Annual Convention and Scientific Assembly

• Presented posters, they worked on with a multiple myeloma experts immediately following the Jane Cooke Wright Symposium

• 2 students delivered oral presentations at a NMA session

Over 750,000 visits to M-Power site!

M-Power Website

Diversity in Clinical Trials Program

Objective: To promote trust and educate patients regarding clinical trials, particularly those from populations underserved by clinical trials, laying the groundwork for potential future trial participation

1.Identify Myeloma Patients who have been on a trial from historically underrepresented groups

2.Diversity in Clinical Trials Academy

• The patients and partners attended an in-person training on the ABCs of Clinical Trials, unconscious bias, reasons for participation in trials, limitations of trials, informed consent, and how to effectively relate their personal stories.

• They were recorded sharing their stories and their interaction with clinical trials

3.Rollout of the program

This will be incorporated into IMF in-person meetings, videos, the IMF website, articles, podcasts, social media campaigns, and support group curricula

Conclusions

• Health disparities are sadly prevalent across all diseases, but particularly in multiple myeloma in the Black community

• KNOW the signs/symptoms of myeloma – Fatigue, Pain and Anemia

• If you know someone with myeloma, we are here for you!

• The IMF’s M-Power is designed to reduce the inequity by ENGAGING the community, EDUCATING primary care providers and ENHANCING the care of patients with myeloma...

What Can I Do??

•Be more conscious of the topics of health equity

•Evaluate the opportunities in your experience to reduce disparities

•Support the M-Power movement!

BREAKOUT SESSION 2

PLEASE HEAD TO YOUR SELECTED BREAKOUT SESSION:

BREAKOUT A: PATIENTS ONLY – LESSONS LEARNED

Please remain in this room

BREAKOUT B: CARE PARTNERS ONLY

Please move to the Severance Room (4th floor)

BREAKOUT A: PATIENTS ONLY – LESSONS LEARNED

Ask The Experts w/ Guest Faculty

Controversies in Myeloma: Moderated by Dr. Joseph Mikhael

Ohio State University Comprehensive Cancer Center, Columbus, OH

Cleveland Clinic, Cleveland, OH

Cleveland Clinic, Cleveland, OH

CLOSING REMARKS & EVALUATION

SCAN THIS QR CODE FOR KEY IMF RESOURCES

Helpful Links to:

• Slides from Friday & Saturday Programming

• Evaluations for Friday & Saturday Programming

• SparkCures Search Engine specific for the Ohio region

• Ways to Give

OUR MISSION:

Improving the quality of life of myeloma patients while working toward prevention and a cure.

OUR VISION:

A world where every myeloma patient can live life to the fullest, unburdened by the disease.