2026 Detroit MCW FINAL DECK

2026 IMF MYELOMA COMMUNITY WORKSHOP

DETROIT, MI

JUNE 27, 2026

MORNING AGENDA

9:00 – 9:15AM Welcome & Announcements

9:15 – 9:45AM Understanding Myeloma Basics

9:45 – 10:00AM (Video) Closing the Gap: Health Disparities in Myeloma

10:00 – 10:15AM Advancing Treatment Options Through Clinical Trials

10:15 – 10:45AM Q&A with Panel

10:45 – 11:00AM Coffee Break

11:00 – 12:00PM Breakout: Frontline or Relapsed Treatment Approaches

-NDMM: Getting Started with Myeloma Management -RRMM: Continuing the Myeloma Treatment Journey

12:00 - 12:40PM LUNCH

AFTERNOON AGENDA

12:40 – 1:25PM Find Your Path: Navigating Your Myeloma Journey

1:25 – 1:55PM Living the Myeloma Life: Local Myeloma Care Partner

1:55 – 2:20PM The Unseen Impact of Myeloma: Taking Care of your Emotional Health

2:20 – 3:05PM Q&A with Panel

3:05 – 3:15 PM Closing Remarks

3:15 – 3:30PM Coffee/Network

SCAN THIS QR CODE FOR KEY IMF RESOURCES

Helpful Links to:

• Slides from today’s programming

• Evaluations for this program

• SparkCures Search Engine specific for the Detroit region

• Ways to Give

OUR MISSION

Accelerating the prevention and cure of myeloma and improving the quality of life for patients and families

MEET THE SUPPORT GROUP TEAM!

Robin Tuohy Vice President, Patient Support

• 25+ Year Care Partner

• Advocate

Jenn Wieworka Director, Support Groups

• Doctorate-Prepared Nurse

• Clinical Nurse Specialist

Becky Bosley Director, Support Groups

• Oncology Nurse

• Breast & Ovarian

Cancer Survivor

Yara William Associate Director, Support Groups

• Doctor of Public Health

• Community Engager

Katie Atkins Associate Director, Support Groups

• Oncology Social Worker

• Resource Navigator

Cecilia Romero Project & Technology Manager, Support Groups

• Public Health Advocate

• Technology Educator

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

LOCAL SUPPORT GROUPS

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

Las Voces de Mieloma

For Spanish Speaker patients & care partners

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

EDUCATION – WRITTEN

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

YOU ARE NOT ALONE

UNDERSTANDING MYELOMA BASICS

REED FRIEND, MD

ATRIUM HEALTH LEVINE CANCER INSTITUTE, CHARLOTTE, NC

Understanding Myeloma Basics

Community Workshops

How common is Myeloma in the US?

How common is Myeloma?

Percent of New Cases by Age

What Causes Myeloma?

How/Why Did I Get This?

Environmental Factors:

• Exposure to some chemicals

• Radiation exposure

Examples:

 Agent Orange

 Burn pits

 Pesticides, Herbicides

 Firefighter/First Responder exposures

Individual Factors:

• Age

• Family History of related disorders

• Personal History of MGUS or SMM

• Obesity

VA Study Documents Health Risks for Burn Pit Exposures

Leukemia and Multiple Myeloma Set to Be Added to List of Conditions Linked to Burn Pits

In most cases, the honest truth

WE DON’T KNOW

What is the Connection Between Bone Marrow & Myeloma ?

Hematopoietic stem cell

Red Blood Cells Carry Oxygen White Blood cell Fight Infection Platelets Prevent Bleeding

Understanding (Mono)clonal Plasma Cells

Heavy Chain: G, A, M, D, E

Heavy Chain = M-Spike

 65% IgG – most common

 20% IgA – associated with AL Amyloid

 5% to 10% light chain-only (kappa, lambda)

 Less common: IgD, IgE, IgM

Is Myeloma the Only Protein Disorder?

• AL-Amyloid

• POEMS

• Light or Heavy Chain Deposition Disease

• MGCS = Clinical

• MGRS = Renal

Condition MGUS1-4 (Monoclonal Gammopathy of Undetermined Significance)

1-5,8 (Smoldering Multiple Myeloma)

• MGNS = Neuro * In clinical trial

Multiple Myeloma and Myeloma Defining Events

Test Name

Testing For Myeloma: Blood & Urine

What it means

CBC + differential

Complete metabolic panel

Beta-2 Microglobulin (B2M)

Lactate Dehydrogenase (LDH)

Serum Immunofixation and Protein electrophoresis (SPEP+IFE)

Immunoglobulins (G, A, M, D, E)

Free light chain assay with kappa/lambda ratio

Urine immunofixation & protein electrophoresis (UPEP+IFE)

Hemoglobin, WBC, Platelets

Creatinine, Calcium, Albumin, Liver function

Part of staging and risk stratification

Measures the level of normal and clonal protein

Identifies the type of clonal protein

Measures the level of normal and clonal protein

Identifies the type of clonal protein

Imaging:

Testing For Myeloma: Imaging

– Skeletal survey: Series of X-rays; less sensitive than other techniques

– Whole body low dose (CTWB-LD CT )

– Positron Emission Tomography (PET/CT)

– Magnetic Resonance Imaging (MRI)

Healthy bone versus myeloma bone disease

Testing For Myeloma: Bone Marrow

Bone marrow biopsy & aspirate

• Bone marrow plasma cells (%)

• Congo Red staining if concern for

Bone marrow genetics

• Cytogenetics

• Fluorescence in situ hybridization (FISH)

• Next generation sequencing (NGS)

(p53del)

*15-20% of people with NDMM

What is the Myeloma Treatment Landscape?

Initial Therapy (a.k.a. Frontline, Induction) Quad Therapy (ex. CD38+ MoAb + VRd)

Cell

Drug Class Overview

(thalidomide)

(lenalidomide)

(pomalidomide)

(daratumumab) Sarclisa (isatuximab)

(elotuzumab)

Drug Class Overview

Peptide Drug Conjugate* Pepaxto (Melphalan Flufenamide) Melflufen IV

BCMA Targeted Antibody Drug Conjugate (ADC)

Blenrep (belantamab mafodotinblmf) Bela, Belamaf, or B

Abecma (idecabtagene vicleucel) Ide-cel

CAR T Cell therapy

Bispecific Antibodies

Pipeline

Carvykti (ciltacabtagene vicleucel) Cilta-cel

Tecvayli (teclistimab)

Talvey (Talquetamab)

Elrexfio (Elranatamab)

Lynozyfic (Linvoseltamab

Tec Talq Elra Linvo

Cevostamab, Iberdomide, Mezigdomide, Anito-cel, Venetoclax

AZD0120, Etentamig, KLN-1010, Trispecifics …………………………… MORE TO COME!

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

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

When Do I Need A New Treatment?

• Not every relapse requires immediate therapy

• Each case is different

Symptomatic or extramedullary disease

Asymptomatic high-risk disease or rapid doubling time or extensive marrow involvement

Initiate Treatment

Asymptomatic biochemical relapse on 2 consecutive assessments

Consider Observation Monitor Carefully Consider Treatment Patient-/Disease-Specific Monitor Carefully

Targets on the Myeloma Cell Surface and Therapeutic Antibodies

Bi-Specific Antibodies

Talvey (Talquetamab) CAR-T

Antibody Drug

Empliciti (Elotuzumab)

Bi-Specific Antibodies

Bi-Specific Antibodies

CAR-T

Monoclonal Antibodies

Daratumumab and Darzalex Faspro Sarclisa (Isatuximab) TAK-079 MOR202

Immune Therapies

Abecma (Ide-cel CAR-T)

Carvykti (Cilta-cel CAR-T)

Tecvayli (Teclistamab)

Elrexfio (Elranatamab)

Lynozyfic (Linvoseltamab)

Other CAR-Ts

Other Bi-Specific Antibodies

How it works:

An antibody directed at a target (BCMA) combined with a cytotoxic agent (chemotherapy) Blenrep(belantamabmafodotin)combinations

ADC = Antibody-Drug Conjugate

BCMA = B-Cell Maturation Antigen

ADCP/ADCC = Antibody-Dependent Cellular Cytotoxicity & Phagocytosis

Bispecific Antibodies: Mechanism of Action

• Incorporates 2 antibody fragments to target and bind both tumor cells and T cells

• Brings target-expressing MM cells and T cells into close proximity, enabling T cells to induce tumor-cell death

Targets of Bispecific Molecule Vary

“Off the Shelf” Advantage

• No manufacturing process, unlike CAR T-cell therapy (but like ADC/belantamab therapy)

• Thus, no delay between decision to treat and administration of drug

ADC = Antibody-Drug Conjugate; BCMA = B-Cell Maturation Antigen; CD3 = Cluster of Differentiation 3; FcRH5 = Fc receptor-homolog 5; GPRC5D = G-protein coupled receptor family C group 5 member D

Image Source: Shah N, et al. Leukemia. 2020;34:985–1005. Creative Commons License:

The Process of CAR T Cell Therapy

CAR T therapy recommended. Insurance approved and ready to move forward.

What about Cure in Myeloma?

Defining “Cure” has many considerations:

 We have historically called myeloma “incurable” as such a small fraction of patients remained in long term remission

 Elimination of disease, down to Minimal Residual Disease Negative (MRD-)

 Prolonged deep response Off Therapy

 Survival continues to improve in MM with an average over 10 years now!

 A recent DRAFT definition is being considered:

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

Second/Expert Opinion

• You have the right to get a second opinion. Insurance providers may require second opinions.

• A second opinion can help you:

– Confirm your diagnosis

– Give you more information about options

– Talk to other experts

– Introduce you to clinical trials

– Help

you learn which health care team you’d like to work with, and which facility

CLOSING THE GAP: HEALTH DISPARITIES IN MYELOMA

JOSEPH MIKHAEL, MD, MED, FRCPC, FACP, FASCO

IMF MEDICAL ADVISOR

ADVANCING TREATMENT OPTIONS THROUGH CLINICAL TRIALS

CRAIG COLE, MD

WAYNE STATE UNIVERSITY - KARMANOS CANCER INSTITUTE, DETROIT, MI

Advancing Treatment Options Through Clinical Trials

International Myeloma Foundation

Myeloma

Community Workshop – Detroit, MI

Saturday, June 27, 2026

Craig Emmitt Cole, MD

Barbara Ann Karmanos Cancer Institute

Associate Professor

Wayne State University School of Medicine

Clinical Associate Professor

Michigan State University College of Human Medicine

Multiple

Discussion Points

• Level setting: Interpreting data in clinical trials

• Disparities in Clinical Trials

• Solutions: Clinical Trials

• Fact or Myth of Clinical Trials

• Finding a Clinical Trial for YOU!

• Where do Emerging Therapies Come From?...Clinical Trials

What are we talking about?

Definitions in Myeloma Treatment

Symptomatic Myeloma

Partial response: PR

How long did it work/ what are the side effects?

AE: Adverse Events- Side effects

>1 Billion >10 Million 1 myeloma cell in 100K to 1 million normal cells Treatment

≥50% reduction in M protein or FLC

Very Good Partial Response: VGPR

≥90% reduction in M protein or FLC or immunofixation positive only

Complete Response: CR

No M-protein/ Normal FLC ratio immunofixation negative

Minimal Residual Disease: MRDFlow Cytometry: 1x10-5 At diagnosis >1 Trillion

Minimal Residual Disease: MRDNext Generation Molecular testing: 1x10-6

What are we talking about?

Kaplan–Meier Survival Curves

• A Kaplan-Meier curve is a visual representation of how many patients on a study respond over time

• Displayed as a graph where each step down represents an event (like loss of response)

• Allowing comparison of survival rates between different groups by looking at how quickly the curves drop

 A steeper curve indicates a higher event rate and worse outcome

 A flatter curve means a lower event rate and better outcome

What are we talking about? Types

of Clinical Trials….

Phase 1: investigates for safety and side effects, as well as dosage (RP2D) and best way to give treatment.

• Includes 20 or more people

Accelerated approval

Phase 2: determines how well does it work and safety.

• Includes 50 to 300 people

Phase 3: looks at effectiveness, side effects and safety in comparison with other standard treatments

• Includes 100s to 1000s of people

Phase 4: gathers more information after approval

40 approvals for 20 drugs in myeloma

“If

trials do not include minorities, then there is a question of whether or not the results of the studies are relevant to everyone across the board.” NIH. Accessed May 19, 2023.

http://www.cancer.gov/newscenter/benchmarks-vol6-issue4/page1

Differences

in Myeloma Incidence, Mortality, and Enrollment in Clinical Trials

Leading to FDA Approval

Patients Enrolled in FDA Trials by Race and by Indications (%)

Loree. JAMA Oncol. 2019;5:e191870. Bhatnagar. ASH 2017. Abstr 4352.

Solutions for Diversity in Multiple Myeloma Clinical Trials

Hartley-Brown M, et al.. Clin Lymphoma Myeloma Leuk. 2024;24:32. Merz L,et al. Semin Hematol. 2024 Oct 25:S0037-1963(24)00125-2.

The MMRF Horizon Trial Commitment

Enrolling a Representative US Multiple Myeloma Patient Population

• The Multiple Myeloma Research Consortium (MMRC) has a Health Equity Advisor

• In our efforts to ensure we are reaching all patients, we have:

– Conducted the two MMRC Site Surveys on Recruitment and Enrollment of Representative Patient Populations

– Expanded the MMRC Horizon trial study sites by adding nearly 25 community sites, including the first ever MM clinical trial in Flint, Michigan

– Implemented a clinical study site-based screening and enrollment information collection tool to understand recruitment efforts, demographics, and patient decisions around clinical trials participation

– Initiated the MMRC CARE Workgroup: A Collaborative Approach to Recruitment and Enrollment

What do you think about Clinical Trials?

If I enter a clinical trial, there’s a good chance that I could receive a placebo

Fact or Myth

Fact: Placebos are rarely used in cancer clinical trials

Clinical trials are riskier than FDAapproved drugs

Fact or Myth

Fact: Treatment on a clinical trial has as good a chance for success as standard treatment

The trial is more important than the patient.

Fact or Myth

Fact: Never! You can stop your participation on a clinical trial at ANY TIME and for ANY reason.

What do you think about Clinical Trials?

If my doctor doesn’t mention clinical trials, it must not be right for me.

Fact or Myth

Fact: Your doctor may not be aware or that there is clinical trial for you.

Finding a Clinical Trial for YOU!

Where do Emerging Therapies in Multiple Myeloma Come From?...

Clinical Trials

Clinical trial

Clinical trial

Clinical trial

Standard of Care

Standard of Care Standard of Care

Clinical trial

Standard of Care

Clinical trial

Standard of Care

Standard of Care Side

Clinical trial

Q&A WITH GUEST PANEL

NEWLY DIAGNOSED MULTIPLE MYELOMA:

GETTING STARTED WITH MYELOMA MANAGEMENT

REED FRIEND, MD

ATRIUM HEALTH LEVINE CANCER INSTITUTE,

CHARLOTTE, NC

Frontline Multiple Myeloma BREAKOUT

IMF Community Workshops

Objectives

• Review the importance of DEPTH of response in early treatment of myeloma and the increasing use of MRD testing

• Discuss emerging approaches in transplant eligible patients, including quadruplet therapy and stem cell transplantation

• Outline the approach to a patient not going to transplant and how to optimize therapy

Goals of Therapy: The Iceberg Model of Myeloma

Treatment

>1 Billion

>1 Trillion D i s e a s e B u r d e n ( # o f m y e l o m a c e l l s )

>10 Million

1 myeloma cell in 100K to 1 million normal cells

Symptomatic Myeloma

At diagnosis

Partial response

50% reduction in M protein

Very good partial response 90% reduction in M protein immunofixation positive only

Complete remission No M-protein immunofixation negative

Minimal Residual Dis Flow Cytometry

Minimal Residual Dis

Next Generation Molecular testing

Depth of response matters!

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

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

DEPTH

MR→PR→ VGPR→CR →sCR

1.

minimal response; neg, negative; pos, positive; R, relapse

MRD is Prognostic – Both for PFS and OS

JJ,

B, et al. J Clin Oncol. 2017; 35(25): 2900–2910

What about Smoldering Myeloma?

• Recall that all patients prior to having active myeloma, have MGUS (monoclonal gammopathy of undetermined significance) then SMM (smoldering myeloma)

• Historically we have not treated smoldering myeloma, but redefined MM to include “ultra-high risk smoldering myeloma”

• But now clinical trials are being conducted in patients with smoldering myeloma – mostly “high risk”

• High risk SMM is defined in different ways, often including at least 2 out of 3 of the following factors:

• M spike 2 or more

• Light chain ratio (involved/uninvolved) 20 or over

• Bone Marrow Plasmacytosis of 20% or higher

Phase 3 Randomized Study of Daratumumab Monotherapy Versus Active Monitoring in Patients With High-risk Smoldering Multiple Myeloma: Primary Results of the AQUILA Study

Meletios A Dimopoulos1, Peter M Voorhees2, Fredrik Schjesvold3, Yael C Cohen4, Vania Hungria5, Irwindeep Sandhu6 ,

Jindriska Lindsay7, Ross I Baker8, Kenshi Suzuki9, Hiroshi Kosugi10, Mark-David Levin11, Meral Beksac12 , Keith Stockerl-Goldstein13, Albert Oriol14, Gabor Mikala15, Gonzalo Garate16, Koen Theunissen17, Ivan Spicka18 ,

Anne K Mylin19, Sara Bringhen20, Katarina Uttervall21, Bartosz Pula22, Eva Medvedova23, Andrew J Cowan24 , Philippe Moreau25, Maria-Victoria Mateos26, Hartmut Goldschmidt27, Tahamtan Ahmadi28, Linlin Sha29, Els Rousseau30 , Liang Li29, Robyn M Dennis31, Robin Carson32, S Vincent Rajkumar33

1National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; 2Levine Cancer Institute, Atrium Health Wake Forest University School of Medicine, Charlotte, NC, USA; 3Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway; 4Tel-Aviv Sourasky (Ichilov) Medical Center and Tel Aviv University, Tel Aviv, Israel; 5Clínica Medica São Germano, São Paulo, Brazil; 6Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada; 7Kent and Canterbury Hospital, Kent, UK; 8Perth Blood Institute, Murdoch University, Perth, Australia; 9Japanese Red Cross Medical Center, Tokyo, Japan; 10Ogaki Municipal Hospital, Ogaki City, Japan; 11Albert Schweitzer Hospital, Dordrecht, The Netherlands; 12Ankara University, Ankara, Turkey; 13Washington University School of Medicine, St. Louis, MO, USA; 14Institut Català d'Oncologia and Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona, Spain; 15South-Pest Central Hospital, National Institute for Hematology and Infectious Diseases, Budapest, Hungary; 16Hospital Alemán, Buenos Aires, Argentina; 17Jessa Hospital, Hasselt, Belgium; 18Charles University and General Hospital, Prague, Czech Republic; 19Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 20SSD Clinical Trials in Oncol-ematologia e Mieloma Multiplo, AOU Città della Salute e della Scienza di Torino, Torino, Italy; 21Medical Unit Hematology, Karolinska University Hospital, Stockholm, Sweden; 22Institute of Hematology and Transfusion Medicine, Warszawa, Poland; 23Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; 24University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA; 25University Hospital Hôtel-Dieu, Nantes, France; 26University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain; 27GMMG Study Group at University Hospital Heidelberg, Internal Medicine V, Heidelberg, Germany; 28Genmab US Inc., Plainsboro, NJ, USA; 29Janssen Research & Development, LLC, Shanghai, China; 30Janssen Research & Development, Beerse, Belgium; 31Janssen Research & Development, LLC, Raritan, NJ, USA; 32Janssen Research & Development, LLC, Spring House, PA, USA; 33Mayo Clinic, Rochester, MN, USA.

Presented by MA Dimopoulos at the 66th American Society of Hematology (ASH) Annual Meeting & Exposition; December 7-10, 2024; San Diego, CA, USA

https://www.congresshub.com/ASH2024/ Oncology/Daratumumab/Dimopoulos

The QR code is intended to provide scientific information for individual reference, and the information should not be altered or reproduced in any way.

AQUILA: Study Design

AQUILA enrollment period: December 2017 to May 2019 at 124 sites in 23 countries

Screening

Key eligibility criteria:

• ≥18 years of age

• Confirmed SMM diagnosis (per IMWG criteria) for ≤5 years

• ECOG PS score of 0 or 1

• Clonal BMPCs ≥10% and ≥1 of the following risk factors:

- Serum M-protein ≥30 g/L

- IgA SMM

- Immunoparesis with reduction of 2 uninvolved Ig isotypes

- Serum involved:uninvolved FLC ratio ≥8 and <100

- Clonal BMPCs >50% to <60%

All patients were required to have CT/PET-CT and MRI imaging during screening

Treatment/active monitoring phase Follow-up phase

DARA monotherapy

1800 mg SCb QW Cycles 1-2, Q2W Cycles 3-6, Q4W thereafter in 28-day cycles until 39 cycles/36 months*

Active monitoring

No disease-specific treatment, with AE monitoring up to 36 months*

• Efficacy follow-up until progression by SLiM-CRAB

• Survival follow-up every 6 months until end of study

Primary endpoint:

• PFS by IRC per IMWG SLiM-CRAB criteriac Key secondary endpoints:

• ORR

• Time to first-line treatment for MM

• PFS on first-line treatment for MM

• Overall survival

*Or confirmed disease progression (whichever occurred first).

Stratified by number of risk factorsa for progression to MM (<3 vs ≥3)

Disease evaluation schedule

• Laboratory efficacy – Every 12 weeks by central lab until disease progression

• Imaging (CT/PET-CT, MRI) – Yearly (central review)

• Bone marrow – At least every 2 years

IMWG, International Myeloma Working Group; ECOG PS, Eastern Cooperative Oncology Group performance status; BMPC, bone marrow plasma cell; FLC, free light chain; CT, computed tomography; MRI, magnetic resonance imaging; QW, weekly; Q2W, every 2 weeks; Q4W, every 4 weeks; AE, adverse event; IRC, independent review committee; ORR, overall response rate. aRisk factors included involved:uninvolved FLC ratio

8 (yes vs no), serum M-protein

30 g/L (yes vs no), IgA SMM (yes vs no), immunoparesis (reduction of 2 uninvolved immunoglobulins vs other), or clonal BMPCs (>50% to <60% vs 50%). bDARA SC (1800 mg co-formulated with recombinant human hyaluronidase PH20 [rHuPH20; 2,000 U/mL; ENHANZE® drug delivery technology; Halozyme, Inc.]). cPFS was defined as duration from randomization to initial documented progression to active MM or death due

AQUILA: Progression to MM by IMWG SLiM-CRAB Criteria (IRC Assessment)

follow-up: 65.2 months

AQUILA: Overall Survival

*Deaths due to an event occurring after the AE reporting window (ie, events that happened after patient started subsequent therapy or >30 days after last dose) or deaths with unknown reason.

Early intervention with fixed duration DARA extended overall survival versus active monitoring

AQUILA: Safety Overview

Points for Smoldering Myeloma

• Wow this is a VERY important study and may well change the way we think about and treat high risk smoldering myeloma

• The study was critical to really prove we can delay the progression to active myeloma and even improve survival with 3 years of daratumumab

• It underscores the importance of a DISCUSSION with the health care team as many options can be offered to patients with high risk smoldering MM

• There will be MANY more trials coming in this area, with even more intense therapies like combinations and even CAR T Cell therapy...

Personalized Approach to Frontline Therapy

Newly Diagnosed MM and Risk

Stratified

Factors to be considered for ASCT

Age, performance status (PS), comorbidities (R-MCI score, HCT-Cl) and organ function

ASCT Eligible

ASCT Ineligible

General Principles of Initial Therapy

1. Most patients will be given a combination of drugs to control the disease quickly- usually a QUADRUPLET

2. We don’t “save the best for last” because early therapies have a long term effect on survival

3. We seek a DEEP and DURABLE response

4. We mix and match from the 3 major classes of drugs and add steroids: Proteasome Inhibitors – most often bortezomib (Velcade) Immunomodulatory Drugs – lenalidomide (Revlimid) Monoclonal Antibodies – daratumumab (Darzalex) and Isatuximab (Sarclisa)

5. We decide early on whether or not someone will have a stem cell transplant

Quads are now the norm...

• QUADRUPLET therapies are becoming the standard of care for MOST (but not all) patients with newly diagnosed MM

• DVRD and Isa-VRD combinations below now FDA approved

• Transplant Eligible

• Darzalex-Velcade-Revlimid-Dexamethasone (PERSEUS)

• Transplant Ineligible

• Sarclisa-Velcade-Revlimid-Dexamethasone (IMROZ)

• Sarclisa-Velcade-Revlimid-Dexamethasone (BENEFIT)

• Darzalex-Velcade-Revlimid-Dexamethasone (CEPHEUS)

PERSEUS: Study Design

Induction

V: 1.3 mg/m2 SC Days 1, 4, 8, 11

R: 25 mg PO Days 1-21

d: 40 mg PO/IV Days 1-4, 9-12

Consolidation

Maintenance

VRd administered as in the VRd group

Primary endpoint: PFSc Key secondary endpoints: Overall CR rate,c overall MRD-negativity rate,d

D-R until PD Discontinue DARA therapy only

Discontinue DARA therapy only after 24 months of D-R maintenance for patients with CR and 12 months of sustained MRD negativity

Restart DARA therapy upon confirmed loss of CR without PD or recurrence of MRD

ECOG PS, Eastern Cooperative Oncology Group performance status; V, bortezomib; SC, subcutaneous; PO, oral; d, dexamethasone; IV, intravenous; QW, weekly; Q2W, every 2 weeks; PD, progressive disease; Q4W, every 4 weeks; MRD, minimal residual disease; CR, complete response; OS, overall survival; ISS, International Staging System; rHuPH20, recombinant human hyaluronidase PH20; IMWG, International Myeloma Working Group; VGPR, very good partial response. aStratified by ISS stage and cytogenetic risk. bDARA 1,800 mg co-formulated with rHuPH20 (2,000 U/mL; ENHANZE  drug delivery technology, Halozyme, Inc., San Diego, CA, USA). cResponse and disease progression were assessed using a computerized algorithm based on IMWG response criteria. dMRD was assessed using the clonoSEQ assay (v.2.0; Adaptive Biotechnologies, Seattle, WA, USA) in patients with VGPR post consolidation and at the time of suspected CR. Overall MRD-negativity rate was defined as the proportion of patients who achieved both MRD negativity (10 –5 threshold) and CR at any time.

Phase 3 Study Results of Isatuximab, Bortezomib, Lenalidomide, and Dexamethasone (Isa-VRd) Versus VRd for

Transplant-Ineligible Patients With Newly Diagnosed Multiple Myeloma (IMROZ)

Thierry Facon,1 Meletios-Athanasios Dimopoulos,2 Xavier Leleu,3 Meral Beksac,4,5 Ludek Pour,6

Roman Hajek,7 Zhuogang Liu,8 Jiri Minarik,9 Philippe Moreau,10 Joanna Romejko-Jarosinska,11 Ivan Spicka,12

Vladimir Vorobyev,13 Michele Cavo,14 Hartmut Goldschmidt,15 Thomas Martin,16 Salomon Manier,17

Marie-France Brégeault,18 Sandrine Macé,18 Christelle Berthou,18 Robert Z. Orlowski19

1Department of Haematology, University of Lille, and French Academy of Medicine, Paris, France; 2Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece; 3Service d'Hématologie et Thérapie Cellulaire, CHU and CIC Inserm 1402, Poitiers Cedex, France; 4Department of Hematology, Ankara University, Ankara, Turkey; 5Istinye University Ankara Liv Hospital, Ankara, Turkey; 6Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic; 7Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 8Shengjing Hospital of China Medical University (Huaxiang Br), Shenyang, China; 9Department of HematoOncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic; 10Department of Hematology, University Hospital HôtelDieu, Nantes, France; 11Department of Lymphoid Malignancies, Marie Sklowdoska-Curie National Research Institute of Oncology, Warszawa, Poland; 12Charles University and General Hospital in Prague, Prague, Czech Republic; 13SP Botkin Moscow City Clinical Hospital, Moscow, Russia; 14IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Università di Bologna, Bologna, Italy; 15Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; 16Department of Hematology, University of California at San Francisco, San Francisco, California, USA; 17Department of Hematology, University Hospital Center of Lille, Lille, France; 18Sanofi, R&D, Vitry-sur-Seine, France; 19Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

ID #OA-49

Study design: Isa-VRd vs VRd in transplant-ineligible NDMM

Initiation phase (4 x 6-week

Treatment until PD, unacceptable toxicities, patient withdrawal

Primary endpoint: PFS

Key secondary endpoints: CR rate, MRD– CR (NGS, 10-5) rate, ≥VGPR rate, OS

(bone marrow aspirate)

In case of CR or VGPR

*Patients considered Ti due to age or comorbidities.

†In the maintenance phase, patients randomized to the VRd arm who experience PD may cross over to receive Isa-Rd.

‡10 mg/day if eGFR 30 to <60 mL/min/1.73 m2 .

§If aged ≥75 years, d was administered on days 1, 4, 8, 11, 15, 22, 25, 29, and 32.

C, cycle; CR, complete response; d, dexamethasone; eGFR, estimated glomerular filtration rate; Isa, isatuximab; MRD, minimal residual disease; NDMM, newly diagnosed multiple myeloma; NGS, next-generation sequencing; OS, overall survival; PD, progressive disease; PFS, progression-free survival; PO, orally; R, lenalidomide; SC, subcutaneous; Ti, treatment-ineligible; V, bortezomib; VGPR, very good partial response. Orlowski RZ, et al. ASCO 2018.

Baseline characteristics

Patient characteristics were balanced in both arms

*One patient in the Isa-VRd arm had an ECOG PS of 3. †High risk defined as the presence of del(17p) and/or t(4;14) and/or t(14;16), with cutoffs defined in footnote ‡ . ‡Abnormality defined as present in at least 30% of abnormal bone marrow plasma cells for t(4;14) and t(14;16) and 1q21+ (at least 3 copies), and at least 50% of abnormal plasma cells for del(17p). Only one patient had 2 high-risk cytogenetic abnormalities: del(17p) and t(4;14). §1q21+ defined as at least 3 copies of 1q21. Amplification 1q21 defined as at least 4 copies of 1q21. ¶In addition, there were 67 (25.3%; Isa-VRd) and 49 (27.1%; VRd) patients with paramedullary disease and 1 patient in each group with both

and

Primary endpoint met: Interim PFS analysis–IRC assessment in ITT population

60-mo PFS rate: 63.2%

mPFS: NR

60-mo

mPFS: 54.34 months (95% CI, 45.207 to NR)

*Cutoff date for PFS analysis: September 26, 2023 (median follow-up, ~5 years). †Nominal one-sided P value. CI, confidence interval; HR, hazard ratio; Isa, isatuximab; ITT, intent-to-treat; mPFS, median PFS; NR, not reached; PFS, progression-free survival; Rd, lenalidomide and dexamethasone; VRd, bortezomib, lenalidomide and dexamethasone. Facon T, Dimopoulos MA, Leleu X, et al. Isatuximab, Bortezomib, Lenalidomide and Dexamethasone for Multiple Myeloma.

BENEFIT Study design: Isa-VRd vs Isa-Rd in Ti NDMM

†Cycle 1 only. CR, complete response; Cy, cycle; d, dexamethasone;

PRESENTED BY: Xavier Leleu, MD, PhD

Quadruplet Frontline Summary

• Quadruplets are indeed better than triplets in patients going to transplant

• They also seem to be better in transplant ineligible patients but with some caveats

• we have less evidence in patients over 80

• dosing of drugs is CRITICAL to ensure tolerability

• Revlimid – we don’t need 25mg in most patients

• Velcade – should be given weekly – still unclear as to length of time

• Dexamethasone – DOWN with DEX! – we can taper and discontinue in the first 4-6 months

• Darzalex-VRD for transplant eligible and transplant ineligible FDA approved!

• Sarclisa-VRD for transplant ineligible now FDA approved!

HISTORICAL TREND TOWARD OPTIMAL DEXAMETHASONE DOSING

Dose

Dose

Dose

40 mg x 12 days per month x 6 months

40 mg x 4 days per month x 6 months

Harding and Mikhael, Blood Editorial “Down with dex!” 2025

Optimal dose yet to be defined

Do we really still need transplant??

RVD +Stem Cell Transplant vs. RVD without Transplant

DETERMINATION Trial of Newly Diagnosed MM: DESIGN

-Patients aged 18-65 yrs with symptomatic newly diagnosed MM following 1 cycle of RVD -56 sites within the United States from 2010 to 2018

End Points of Study and Follow-up

Melphalan 200 mg/m2 + Stem Cell Support (n = 310)

• Primary end point: progression-free survival (time to next relapse)

• Secondary end points included:

• Response rates, overall survival, quality of life, and adverse events

• Follow-up on participant status : median of 6 years

Primary endpoint: Progression-free survival (PFS)

CI, confidence interval; HR, hazard ratio; Data cut off: 12/12/21

1.53 (1.23–1.91), p<0.0001

Key secondary endpoint: Overall survival (OS)

Median follow-up 76 months Data cut off:12/12/21

*p-value adjusted using Bonferroni’s correction to control overall family-wise error rate for secondary outcomes

DETERMINATION Trial of Newly Diagnosed MM Quality of Life

Global Health Status/QoL, Physical Functioning

DETERMINATION Discussion

• ASCT remains very relevant and important in prolonging PFS in younger and eligible patients

• BUT it may not be mandatory in all eligible patients upfront

• As with other agents, we INDIVIDUALIZE the sequencing patterns

• ASCT does carry genuine toxicity, short term and long term

• We may become callous to these toxicities

• Maintenance therapy remains an important part of myeloma therapy

What about patients not eligible for transplant?

• As noted before, quadruplets are now becoming the standard of care for most patients

• However, some patients may not be “quad eligible”

• In these patients, triplets, or even doublets may be considered

• The most commonly used regimen is DRD – darzalex, revlimid and dex

• this is based on the MAIA trial of DRD vs RD

• If you are 65 and older a geriatric assessment is recommended by ASCO

Conclusions

• Although historically we have not treated smoldering myeloma, new evidence suggests we can treat patients with high risk SMM with daratumumab monotherapy for 3 years

• D-VRD is the new standard of care in Transplant Eligible Patients

• Isa-VRD or DVRD are the new standard of care in Transplant Ineligible Patients

• DRD or Sarclisa—Rd may still be considered in some patients

• Although ASCT remains the standard of care, use is likely to decline in patients who are 65-75 or with significant comorbidities

• Continuous therapy has resulted in better outcomes

• The balance of toxicity and efficacy is particularly important in this population

• ESPECIALLY with dexamethasone

• Ongoing studies will help us decide if CAR T cell therapy should move upfront and possibly even replace transplant

• What we do frontline has an impact in the long term...

RELAPSED & REFRACTORY MULTIPLE MYELOMA:

CONTINUING THE MYELOMA TREATMENT JOURNEY

CRAIG COLE, MD

WAYNE STATE UNIVERSITY - KARMANOS CANCER INSTITUTE,

DETROIT, MI

Relapsed Refractory Multiple Myeloma: Continuing the

Myeloma Treatment Journey International Myeloma Foundation

Saturday, June 27, 2026

Craig Emmitt Cole, MD

Barbara Ann Karmanos Cancer Institute

Associate Professor

Wayne State University School of Medicine

Clinical Associate Professor

Discussion Points

• Typical Course of Multiple Myeloma

• Relapsed myeloma

• Immune Therapies in Myeloma

Antibody Drug Conjugates

CAR-T

Bispecifics • Trispecifics

The Typical Course of Myeloma

New International Myeloma Working Group (IMWG) Criteria for

Disease Progression

Biochemical Relapse

– Two consecutive (or simultaneous) measurements with any of the following increases:

• >25% increase in the level of serum monoclonal paraprotein, which must also be an absolute increase of 0.5g/dL or

• >25% increase in the 24hr urine light chain excretion , which must also be an absolute increase of at least 200mg/24h or

• >25% increase in the difference between the involved and uninvolved FLC. The absolute increase must be >10mg/dL

Patterns of Relapse MM

Remember:

Check a PET scan at biochemical relapse to rule out new bone lesions

When to Treat Relapsed MM

• Clinical relapse: – Hypercalcemia(>11.5 g/dL)

– Rise in serum creatinine by >2 mg/dL or more, due to myeloma

– Decrease in hemoglobin of >2 g/dL, or to < 10g/dL

– New bone lesions or soft-tissue plasmacytomas

– Definite increase in size of existing bone lesions or plasmacytomas

• Progressive biochemical relapse

Bi-Specific Antibodies

Talquetamab

Ramantamig (Trispecific) CAR-T

Targets on the Myeloma Cell Surface and Therapeutic Antibodies

Antibody Drug

Elotuzumab

Bi-Specific Antibodies

Bi-Specific Antibodies

Cevostamab CAR-T

Antibody Drug

Daratumumab and Darzalex Faspro

Isatuximab

Immune Therapies

Ide-cel CAR-T

Cilta-cel CAR-T

Teclistamab

Elranatamab

Linvoseltamab

Etentamig

Ramantamig (Trispecific)

Antibody Drug Conjugates

Belantamab

Antibody

Drug Conjugates (ADC) in Myeloma

Chemotherapy agent

Monoclonal Antibody

Belantamab mafodotin IV humanized anti-BCMA ADC

● Belantamab mafodotin is an IV humanized anti-BCMA monoclonal antibody conjugated to monomethyl auristatin-F given IV every 3 weeks

● DREAMM-1 study of 35 pts where ADC given as monotherapy in heavily pretreated MM patients (57% have > 5 prior lines of tx)

● ORR=66.7% and median duration of response was 14.3 months.

All pts had at least 1 adverse event the most frequent were corneal (eye) (63%), platelet count decreased (57%), anemia (29%), and cough (26%).

Slit-lamp photograph of the cornea in a patient with belamaf keratopathy

DREAMM-7: Phase

III of a BLENREP triplet (Benrep Velcade dex) vs. a Daratumumab-based triplet combination (Dara Velcade dex) in 2nd Line MM

demonstrated a 59% reduction in the risk of disease progression or death vs. DVd

DREAMM-7: Efficacy (Key

Secondary Endpoints)

Patients at Risk,

DREAMM-7: Overall Survival

Median OS was not reached

Modeling predicts a median OS of 84 mo with BVd vs 51 mo with DVd Mo Since Randomization

The FDA approved Blenrep with bortezomib and dexamethasone for RRMM who have received at least two prior lines of therapy

I attack invaders outside the cells!

I attack misbehaving and mutated cells!

CAR –T Immune Therapy

CAR-T cell therapy 101

I hope… T cells are a type of white blood cell that attack and kill viruses and cancer cells

Program the patient’s T-cells with CAR to recognize and destroy the patient’s own cancer

cells

Chimeric antigen receptors (CARs) help T-cells recognize and destroy cancer cells

CAR-BCMA T-Cells in Myeloma: Background

• B-cell maturation antigen (BCMA) is expressed myeloma cells and is a potential target for CAR T-cell therapy for MM.

• T cells can be genetically modified to express chimeric antigen receptors (CARs) specific for BCMA or other proteins associated with cancer.

• The patient’s own T-cells are stimulated, transduced with BCMA retroviruses, and cultured for 9-14 days before re-infusion.

• The CAR-T cells engage myeloma cells thru BCMA.

– T-cells are activated and then kill the myeloma cells

– The CAR-T cells also have another built-in switch which causes the CAR-Ts to expand in number and potency

Acute Immune-Related Toxicities: CRS and ICANS

Cytokine Release Syndrome (CRS) is a severe inflammation reaction related to Tcell engagement to the target

Signs/symptoms of mass inflammation:

 Fever – cardinal sign

 Hypoxia and/or hypotension – presence and severity guide CRS grading system

 Accompanying symptoms vary

Management:

 Rule out infection

 Tocilizumab – first line; anti–IL-6

 Corticosteroids – add if refractory

 Critical care interventions at higher grades

Immune effector cell-associated neurotoxicity syndrome (ICANS) is the neurologic toxicity of CAR-T and Bispecifics

Neurologic and cognitive signs:

 ICE score decline – cardinal sign

 Altered consciousness and seizure –presence and severity guide ICANS grading system

Management:

 Frequent neurologic assessments

 Corticosteroids – first line

credit: clinicaloptions.com

 Critical care interventions at higher grades Santomasso. JCO. 2021;39:3978.

Anti BCMA CAR T Cells Multiple Myeloma

CARTITUDE-1:

Ciltacabtagene Autoleucel for R/R MM

 Single-arm, open-label phase Ib/II trial conducted in the United States

Screening, enrollment, leukapheresis

Lymphodepletion chemotherapy FLU 30 mg/m2 + CY 300 mg/m2 x 3 days

Ciltacabtagene autoleucel manufacturing (6-8wks)

Ciltacabtagene autoleucel infusion

0.5 x 106 - 1.0 x 106 CAR T-cells/kg (target: 0.75 x 106)

Posttreatment assessments

Postinfusion assessments

Patients with R/R MM with measurable disease after ≥3 prior therapies (N = 97) Follow-up

± Bridging chemotherapy

Efficacy Outcome

Day -5 to -3

Day 1

Patients (N = 97)

credit: clinicaloptions.com

CARTITUDE-1: Updated PFS and OS

 33% of patients were progression- and treatment-free at follow-up of >5 years

of Clinical Oncology 43(25)2025:JCO2500760 Median OS: 60.7 mo (95% CI: 41.9-NE)

CAR-T Clinical Trial Makes News!

International Myeloma Society

Cure Summit Definition:

“IMS cure” is defined as persistent remission at MRD negative at a sensitivity level of 106 and sustained undetected disease. Patients have been off antimyeloma therapy for five years.

Multiple Myeloma Research Foundation. Available at: https://themmrf.org/mmrf-blogs/proposed-definition-cure-multiple-myeloma/. Accessed May 2026

RRMM

• 1-3 prior lines incl PI & IMID

• Refractory to lenalidomide

Cilta-cel CAR-T CARTITUDE-4:

Progression Free Survival and Response

Median follow-up 15.9 months

Risk ratio, 2.2 (95% CI, 1.5-3.1)

P<0.001

Risk ratio, 2.9 (95% CI, 2.3-3.7)

P<0.001

Cilta-cel CAR-T CARTITUTE-4:

Adverse Events

San-Miguel J, et al. NEJM. 2023;389:335-347.

Bi-specific T-cell engagers and antibodies to bring the activated T cells to the cancer

Anti-CD3 (T-Cell) monoclonal antibody

Bi-specific antibody composed of two singlechain antibodies

Anti-tumor monoclonal antibody (such as BCMA or CD19)

Toxicities:

• Cytokine Release Syndrome (CRS)

• Immune effector cell-associated neurotoxicity syndrome (ICANS)

• Infections

Summary of Trials With Bispecific Antibodies

Ententamig Design and Mechanism of Action

Ententamig

Phase I: Efficacy in RRMM ≥3 prior lines of therapy

• Objective response was achieved in 96/145 (66%) patients

• ≥ very good partial response in 79/145 (54%) patients with at least 1 assessment post-dose of etentamig 40 mg or 60 mg

MajesTEC-3: Teclistamab Plus Daratumumab in RRMM

Study Design

MajesTEC-3: Teclistamab Plus Daratumumab in RRMM

Prior Lines of Therapy

MajesTEC-3: Teclistamab Plus Daratumumab in

RRMM

PFS, Response Rates, and Overall Survival

75% of patients were double

R, et al. Presented at: American Society of Clinical Oncology (ASCO) Annual Meeting; May 29-June 2, 2026

RRMM Immunotherapies in

2nd and 3rd lines: Efficacy Comparison across Phase III Trials

Note: Data from cross-trial comparisons should be evaluated with care due to differing trial populations and baseline risk characteristics. All hazard ratios (HR) compare the experimental arm directly against the trial's specific standard-of-care control arm.

TRI-specific T-cell engagers and antibodies to bring the activated T cells to the cancer

Anti-myeloma monoclonal antibody (GPRC5)

Anti-CD3 (T-Cell) monoclonal antibody

Cytoto xic granul e

T Cell

• Dual antigen targeting may enhance tumor response by:

• Circumventing tumor heterogeneity and antigen loss

TRIspecific antibody composed of THREE single-chain antibodies

• Improving potency due to antigen binding strength

• Ramantamig is a trispecific antibody that binds to CD3 on T-cells and BCMA & GPRC5D, on myeloma cells

Anti-myeloma monoclonal antibody (BCMA)

Ramantamig Trispecific:

Study Design

Ramantamig Trispecific:

ORR in Patients Naive or Exposed to BCMA/GPRC5D Therapies

Ramantamig Trispecific:

Individual Response and PFS at the RP2D

Conclusion

• Relapsed myeloma occurs when the disease becomes active after a period of remission

• The new immunotherapies include antibody drug conjugates, CAR-Ts, bispecifics, and now trispecifics

– In clinical trials, these new therapies have consistently been superior to older treatment regimens

• The new standard of care for relapsed myeloma now includes the new immunotherapies which are bringing us closer to a cure

SCAN THIS QR CODE FOR KEY IMF RESOURCES

Helpful Links to:

• Slides from today’s programming

• Evaluations for this program

• SparkCures Search Engine specific for the Detroit region

• Ways to Give

LUNCH

SCAN THIS QR CODE FOR KEY IMF RESOURCES

Helpful Links to:

• Slides from today’s programming

• Evaluations for this program

• SparkCures Search Engine specific for the Detroit region

• Ways to Give

MYELOMA: PUTTING THE PIECES OF THE PUZZLE TOGETHER

CARRIE BELLERIVE, BSN, RN, TCTCN

MEMORIAL SLOAN KETTERING CANCER CENTER, NEW YORK, NY

IMF: NURSE LEADERSHIP BOARD PRESENTATION

June 27, 2026

Carrie Bellerive  BS, RN, TCTCN®

Memorial Sloan Kettering Cancer Center & IMF Nurse Leadership Board Member

Myeloma: Putting the Pieces of the Puzzle Together

Myeloma Basics NDMM Treatment

Living Well

Treatment Managing Symptoms .

Myeloma Is a Cancer of the Plasma Cells

Plasma Cells

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

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

Bone marrow

Myeloma Causes Cell Dysfunction & Symptoms

Anxiety

Stress

Depression

Decreased red blood cells

Decreased white blood cells

Anemia & Fatigue

Immune Dysfunction & Infection

Myeloma protein in blood and urine

Changes in bone remodeling

Clonal myeloma plasma cells can cause many symptoms

• Crowd out normal bone marrow cells

• Produce myeloma protein

• Can cause kidney dysfunction

• Affect bone cells (balance of osteoclasts & osteoblasts)

Renal Dysfunction

Bone Damage

Infections Are Serious for People with Myeloma

Preventing infections is paramount.

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

IMWG = International Myeloma Working Group; HCP = healthcare provider. Raje NS, et al. Lancet Haematol.2022;9(2):143–161. IMF Nurse Leadership Board ONS Symposia 2024.

Preventative and/or supportive medications

Kidney and Bone Health

Protect Kidney Function

Myeloma Treatment

Stay hydrated - drink water

Avoid certain medications

• IV contrast dye

• 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

Protect Bone Health

• Myeloma Treatment

• Nutrition

• Vitamin D

• Calcium (if approved by doctor)

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

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

Report any new or worsening bone pain to your healthcare provider

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)

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.

Nature 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.

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

• Stay informed, understand options

• Use reliable, current information

• Caution with personal stories

• Consider priorities

• Discuss with your care partner

• Consider goals/values/preferences

• Be part of the conversation, create a dialog

• Ask questions

• Efficacy

• Side effects

• Pros and cons

• Express your priorities

• Ask for time to consider options (if needed)

• Arrive at a treatment decision together

• Arrange follow-up to review and adjust (if needed)

New Option: Treatment for High-Risk Smoldering Multiple Myeloma (HR-SMM)

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

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

FDA approved Nov2025

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 shared decision-making with your provider to determine if treatment is right for you.

Treatment of Newly Diagnosed Multiple Myeloma (NDMM)

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

National Comprehensive Cancer Network® (NCCN®) NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines®) for Multiple Myeloma. Version 4.2026. To view the most recent or complete version of the guideline, go online to NCCN.org; Rajkumar et al, 2014. Rajkumar SV. Am J of hematology. 2022;97(8):1086–1107. https://doi.org/10.1002/ajh.26590; Faiman et al, 2016.

Induction Standard of Care

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)

• Kyprolis (carfilzomib)

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

Supportive medication:

Immunomodulatory drug (IMiD)

Revlimid (lenalidomide)

• Pomalyst (pomalidomide)

• 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: An Important Piece 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

Symptoms:

Numbness

Tingling

Prickling sensations

Sensitivity to touch

Burning and/or cold

sensation

Muscle weakness

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). Nerve damage from neuropathy can be permanent. Early reporting of symptoms may prevent

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

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

Measuring treatment response

Location: Transplant Center P H A S E 1

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

Regain strength

Location: Home P H A S E 3

Appetite recovery

Post treatment assessment

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®

Nausea & 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

• Work closely with a dietician to 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

Smith LC, et al. Clin J Oncol Nurs. 2008;12(3)suppl:37-52. Faiman B. Clin J Oncol Nurs. 2016;20(4):E100-E105.

Treatment Options at Relapse

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

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

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

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 with 1-2 prior LOT

BCMA target: potential for infection

• Abecma® (ide-cel)

• Carvykti® (cilta-cel)

• (anito-cel – pending FDA approval)

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

Relapsed MM after 4 prior LOT (or clinical trials)

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.

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

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

• Headache

• Difficulty concentrating

• Lethargy

• Agitation

• Hallucinations

• Tremors

• Confusion

• Memory loss

Neurotoxicit

PREVENTION AND MANAGEMENT of CRS

• Disease management to reduce tumor burden

• Bispecific Step-up Dosing (SUD)

• Tocilizumab

• Steroids

• Anti-Seizure medications

• Close monitoring

• 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;25:625638. Kumar, et al. Blood (2024) 144 (Supplement 1): 4758.

Infection: Medications Can Reduce Risk

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

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 GCSF 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

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

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

Dental Care

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

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

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

Catamero D, Purcell K, Ray C, et al. Presented at the 20th International Myeloma Society (IMS) Annual Meeting Nurse Symposium; September 27–30, 2023; Athens, Greece.

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

Antihistamines, 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

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.

Symptoms are under-reported:

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

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

Healthy Practices: Part of the Big Picture

Adopt Healthy Behaviors

• Mental health / social engagement

• Stress reduction; relaxation

• Sufficient Sleep

• Maintain a healthy weight; eat nutritiously

• Activity / exercise / prevent falls, injury

• Stop smoking

• Sexual health / intimacy

• Complementary or alternative therapy

• Socialize and Connect with others

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

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

Recommended Health Screenings

 Blood pressure

 Cholesterol

 Cardiovascular disease  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.

Care Partners: Essential Pieces of the Puzzle

Multiple studies demonstrate that strong social ties are associated with

• Increased longevity including people with cancer

• 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

Caring for the care partner

• Recognize that caregiving is difficult and stressful

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

• The IMF has information and resources to help care partners

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

LIVING THE MYELOMA LIFE

CHARLES NEWMAN, MS

IMF

BOARD OF DIRECTORS, CARE PARTNER, ADVOCATE

THE

UNSEEN IMPACT OF MYELOMA: TAKING CARE OF YOUR EMOTIONAL HEALTH

JENNIFER WIEWORKA, DNP, RN, OCN

IMF DIRECTOR, SUPPORT GROUPS

Disclaimer

The International Myeloma Foundation Support Group Team presents this information to support learning and conversations with your healthcare team.

This presentation is for informational purposes only and is not intended to provide medical advice or replace guidance from your medical providers.

 Common Emotional Responses

 The Spectrum of Emotions

 Coping with your Emotions

 Grounding Exercises

AGENDA

 When & Where to Seek Help

 Wellness Tips & Resources for Support

 Questions & Discussion

COMMON EMOTIONAL RESPONSES

Myeloma is often seen through the lens of physical symptoms, treatments, and survival rates.

Beneath the surface of this medical battle lies a profound emotional journey that affects not only the person diagnosed but also their loved ones.

Initial Feelings

Getting a diagnosis of cancer can feel like getting the wind knocked out of you.

https://opentextbc.ca/introductiontopsychology/chapter/10-1-the-experience-of-emotion/

Shock & Disbelief

Some patients describe a feeling of numbness or surrealism after a cancer diagnosis; unable to fully grasp the weight of the news.

• Confusion

• Disconnection

• Denial

Anger

It is completely normal to experience anger towards:

• Doctors

• Healthcare team

• Yourself

• God

Fear & Worry

Patients describe many fears after a myeloma diagnosis, including:

• Fear of death and dying

• Fear of pain or treatment

• Fear of rejection/loneliness

• Fear about the future

• Practical worries (finances, housing, career, etc.)

Grieving Shifts in Identity

• Side effects like fatigue, hair loss, nausea, and cognitive changes can strip away one’s sense of normalcy and identity.

• Some people feel isolated as they withdraw from social activities, work, or relationships due to physical limitations or emotional distress.

• The loss of independence and routine can be demoralizing and defeating.

Relationship Challenges

• Cancer can significantly impact relationships with partners, family, friends, and coworkers.

• Some people may not know how to respond or offer support, leading to awkwardness, discomfort, or distance.

• Care partners can also experience emotional exhaustion, guilt, and helplessness as they witness their loved one's suffering.

Anxiety

Symptoms of anxiety include:

• ruminating about a specific fear

• sleep disturbance

• feeling restless or edgy

• irritability

• being easily fatigued or overstimulated

• difficulty concentrating or forgetfulness

Depression

Symptoms of depression include:

Sleep disturbance  Loss of interest/pleasure in activities that used to feel exciting (anhedonia)

• Feelings of guilt or worthlessness

• Changes in energy or excessive fatigue

• Appetite/weight changes

• Psychomotor disturbance

• Suicidal thoughts

• Depressed mood

Prevalence of Depression

• In the US, 23.1% of the general population meet criteria for a diagnosis of a mental health disorder.

• Over 56% of patients living with blood cancers experience anxiety and depression

THE SPECTRUM OF EMOTIONS

Finding Value in the Challenge

• This is never about suggesting the illness itself is “good” or that someone should suffer.

• Rather, it’s about recognizing that within extremely difficult or unwanted experiences, people sometimes discover forms of meaning, strength, connection, or clarity.

Emotional and Spiritual Growth

Research in psycho-oncology shows that post-traumatic growth is surprisingly common. People sometimes describe:

• A greater appreciation for life’s small moments

• New or deepened spiritual beliefs

• A sense of inner strength they didn’t know they had

• Increased empathy or patience

Suffering forces confrontation with vulnerability and uncertainty, and some individuals emerge with a transformed worldview.

Healing Versus A Cure

• We may not yet have a cure for myeloma, and the reality is our physical bodies are never perfect, but we can experience emotional or spiritual healing in the midst of this journey.

• Consider for yourself what it would mean to engage in “healing.”

Hope & Empowerment

Cancer strips away control, but in that loss, people often find a different kind of agency:

• Choosing how to spend meaningful time

• Choosing how to speak about their experience

• Choosing how they meet uncertainty emotionally and spiritually

The struggle becomes a teacher of resilience and presence.

Purpose Through Helping Others

A powerful source of meaning comes from turning personal suffering into support for others:

• Advocating

• Volunteering

• Leading a support group

• Sharing one’s story

• Helping someone newly diagnosed

The idea of “I can use what I’ve been through” gives suffering a sense

of direction.

COPING WITH YOUR EMOTIONS

Coping with Heavy Emotions

• Awareness

• Identify

• Accept

• Recognize

• Stay Curious

• Let go

Coping with Heavy Emotions

Don’t feel that you have to be “strong.”

If you feel tired, lonely, anxious, depressed, angry, etc., acknowledge your feelings and talk about them. If all you want to do is cry, then go ahead.

Crying is a natural catharsis.

Grief & Gratitude

“The work of the mature person is to carry grief in one hand and gratitude in the other and to be stretched large by them.

How much sorrow can I hold? That’s how much gratitude I can give. If I carry only grief, I’ll bend toward cynicism and despair. If I have only gratitude, I’ll become saccharine and won’t develop much compassion for other people’s suffering.

Grief keeps the heart fluid and soft, which helps make compassion possible.”

-Francis Ward Weller

GROUNDING TECHNIQUES

Emotional Grounding Techniques

5-4-3-2-1 Grounding Exercise

The “Pretzel” or other bilateral stimulation exercises

Mindful Walking

4 Square breathing

Categories (i.e. Colors, college football teams, etc.)

Aromatherapy

Hold a piece of ice

Eat a small bite of food with intention and mindfulness

WHEN & WHERE TO SEEK HELP

Practical Help

Think about what you need. Lots of people will want to help but don’t know how.

• Practical needs

• Financial help

• Emotional support

When to Seek Professional Help

Your mental health is as important as your physical health!

Tell your healthcare team or another medical professional if you need support.

Ask if your hematology/oncology clinic employs a clinical social worker or counselor. Emotional support and therapy services are available at many clinics.

WELLNESS TIPS & RESOURCES FOR SUPPORT

Support Groups Provide a Sense of Belonging

• Included

• Welcomed

• Connected

• Accepted

• Involved

• Supported

• Heard

• Valued

• Seen

• Hopeful

Wellness Tips

 Talk to friends and family, and others you trust

 Ask for help and be specific about what you need Join a support group

Get education and information only from reliable/reputable sources

 Take time for yourself

 Spend time with supportive friends

 Celebrate every victory!

Resources

Talk with your doctor to determine what plan of action works best for you. Medications could potentially be part of a treatment plan that you and your doctor work on together.

If you think therapy/counseling could be beneficial, ask for a referral or check out websites/platforms such as:

• Headway

• Better Help

• Talkspace

• CaringBridge

• Psychology Today

Q&A WITH GUEST PANEL

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• Slides from today’s programming

• Evaluations for this program

• SparkCures Search Engine specific for the Detroit region

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