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2026 LA PFS - Friday Slides

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WELCOME TO THE LOS ANGELES PATIENT & FAMILY SEMINAR FRIDAY, AUGUST 14, 2026 HEATHER COOPER ORTNER PRESIDENT & CEO


THANK YOU TO OUR SPONSORS!

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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 California region • Ways to Give • IMF Website © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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AGENDA 1:00 – 1:15PM

Welcome

1:15 – 1:30PM

Hot Topics in Myeloma

1:30 – 2:15PM

Myeloma 101: The Big Picture Perspective

2:15 – 2:45PM

The Unseen Impact of Myeloma: Taking Care of Your Emotional Health

2:45 – 3:00PM

BREAK

3:00 – 3:40PM

Navigating Insurance & Medical Bills

3:40 – 3:55PM

Advocacy Update

3:55 – 4:25PM Simple

Myeloma 202: Immunotherapy Made

4:25 – 4:40PM

Understanding Clinical Trials

4:40 – 5:10 PM

Q&A with Guest Panel

5:10 – 5:15PM

Announcements & Evaluation Completion

5:15 – 6:15PM

Welcome Reception & Networking

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OUR MISSION Accelerating prevention and cure of myeloma and Improving quality of live for patients and families

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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

SGTeam@myeloma.or g © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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MEET THE SUPPORT GROUP TEAM!

Robin Tuohy

Jenn Wieworka

Vice President, Patient Support

• •

25+ Year Care Partner

•

Advocate

•

Director, Support Groups

Doctorate-Prepared Nurse Clinical Nurse Specialist

Becky Bosley Senior Director, Support Groups

Yara William

Associate Director, Support Groups

Katie Atkins

Cecilia Romero

Associate Project & Technology Director, Support Manager, Support Groups Groups

•

Oncology Nurse

•

•

Breast & Ovarian Cancer Survivor

Oncology Social Worker

•

•

Doctor of Public Health

Public Health Advocate

•

Community Engager

•

Resource Navigator

•

Technology Educator

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CALIFORNIA SUPPORT GROUPS Inland Empire

Duarte – City of Hope

Upland

Orange County

Pasadena/San Gabriel

Los Angeles

Rancho Mirage

Westlake

Napa/Sonoma

San Fernando Valley

Santa Cruz

San Diego

Sacramento

San Francisco Bay Area

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SHARED EXPERIENCE GROUPS MM Families For patients & care partners with young children Living Solo & Strong For patients without a care partner Veterans For those who served our country Las Voces de Mieloma For Spanish speakers

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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 10


MYELO

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INFOLINE 800-452-2873 (CURE) Promoting Knowledge, Empowerment, & Hope • Understanding lab results, terminology and disease state • Preparing for medical visits • Access to medical providers, specialty care (ASCT, CAR T)

Paul Hewitt

Missy Klepetar

• Access to specialty medications • Financial resources

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CLINICAL TRIAL MATCHING ENGINE

Powered by SparkCures © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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EDUCATION – AWARENESS - MAM

11.8 K Mentions

60M Reach

346.5K Interactions

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EDUCATION – VIDEO

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EDUCATION – WRITTEN

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IMF RESEARCH LEADERSHIP

Coordinated international leadership advancing prevention, better treatments, and a cure for myeloma © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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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 nearly 400 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

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THANK

YOU !


Let’s Get Social:

Myeloma.org


YOU ARE NOT ALONE

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HOT TOPICS IN MYELOMA Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO IMF Medical Advisor


MYELOMA 101: THE BIG PICTURE PERSPECTIVE WITH Q&A Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO, IMF Medical Advisor


MYELOMA 101: UNDERSTANDING THE BASICS


Understanding Myeloma Basics

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


How common is Myeloma in the US? Estimated New Cases in 2025

36,500

% of All New Cancer Cases

1.8%

Median Age At Diagnosis

69 years

How common is Myeloma?

Percent of New Cases by Age

Rate of New Cases per 100,000 Persons by Race/Ethnicity & Sex © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

https://seer.cancer.gov/statfacts/html/mulmy.html dated 4.18.2025


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 © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

In most cases, the honest truth is ….. WE DON’T KNOW


The Connection Between Bone Marrow & Myeloma Hematopoietic stem cell

Red Blood Cells

White Blood cell

Platelets

Carry Oxygen

Fight Infection

Prevent Bleeding

Photo Credit

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

This Photo by Unknown Author is licensed under CC BY

Graphic Credit: Teresa Miceli


Understanding (Mono)clonal Plasma Cells

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 eGFR = estimated glomerular filtration rate; M-spike = monoclonal spike; Ig = Immunoglobulin

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Image Credit: IMF Patient Handbook

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


• • • • • •

AL-Amyloid POEMS Light or Heavy Chain Deposition Disease MGCS = Clinical MGRS = Renal MGNS = Neuro

Is Myeloma the Only Protein Disorder?

(Monoclonal Gammopathy of Undetermined Significance)

SMM1-5,8

(Smoldering Multiple Myeloma)

Active Multiple Myeloma6-8

Clonal plasma cells in bone marrow

<10%

10%-60%

>10%

Presence of Myeloma Defining Events

None

None

Yes

Likelihood of progression

~1% per year

~10% per year

Not Applicable

Treatment

No; observation

Yes for high risk*; No for others

Yes

Condition

MGUS1-4

* In clinical trial © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

MGCS = clinical significance; MGRS = Renal significance; MGNS = Neuro significance


Multiple Myeloma and Myeloma Defining

Clonal Bone Marrow ≥ 10% Or Bony/Extramedullary Events Plasmacytoma AND any one or more Myeloma Defining Events (MDE) SLiM CRAB

C alcium elevation R enal complications A nemia B one disease

S Clonal BMPC ≥ 60% Li FLC ratio >100

M

>1 focal lesion* by MRI BMPC = Bone marrow plasma cells FLC = serum free light chain * >5 mm

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Rajkumar SV, et al. Lancet Oncology. 2014; 15:e538-e548. Kyle RA, et al. Leukemia. 2010; 24(6):1121–1127.

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Testing For Myeloma: Blood & Urine Test Name

What it means

CBC + differential Complete metabolic panel

Hemoglobin, WBC, Platelets Creatinine, Calcium, Albumin, Liver function

Beta-2 Microglobulin (B2M) Lactate Dehydrogenase (LDH)

Part of staging and risk stratification

Serum Immunofixation and Protein electrophoresis (SPEP+IFE) Immunoglobulins (G, A, M, D, E) Free light chain assay with kappa/lambda ratio

Measures the level of normal and clonal protein Identifies the type of clonal protein

Urine immunofixation & protein electrophoresis (UPEP+IFE)

Measures the level of normal and clonal protein Identifies the type of clonal protein

Rajkumar et al. LancetMyeloma Oncol. 2014;15:e538-3548. Ghobrial IM, et IMF al. Blood. 2014;124:3380-3388; mSMART.org; NCCN.org © 2026, SV, International Foundation. All rights reserved. Confidential

C R A B

This Photo by Unknown Author is licensed under CC BY-SA-NC

S Li M

CBC= Complete Blood Count; WBC = White Blood Cell


Testing For Myeloma: Imaging 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)

S L i M

Healthy bone versus myeloma bone disease

C R A B

This Photo by Unknown Author is licensed under CC BY-NC-ND

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Rajkumar SV, et al. Lancet Oncol. 2014;15:e538-3548. Ghobrial IM, et al. Blood. 2014;124:3380-3388; mSMART.org; NCCN.org


Testing For Myeloma: Bone Marrow This Photo by Unknown Author is licensed under CC BY-SA

Bone marrow genetics • Cytogenetics • Fluorescence in situ hybridization (FISH) • Next generation sequencing (NGS) High Risk FISH Results* Deletions

Translocations

Gain

1p17p- (p53del)

t(4;14) t(14;16) t(14;20)

1q+

Image Credit: IMF Patient Handbook

Bone marrow biopsy & aspirate • Bone marrow plasma cells (%) • Congo Red staining if concern for AL-Amyloid Rajkumar SV, et al. Lancet Oncol. 2014;15:e538-3548. IM,IMF et al. Blood. 2014;124:3380-3388; mSMART.org; NCCN.org © 2026, International Myeloma Foundation. All rightsGhobrial reserved. Confidential

*15-20% of people with NDMM


IMS/IMWG consensus on high-risk myeloma definition Del17p

in more than 20% of sorted plasma cells

TP53 mut

(no threshold VAF)

Biallelic Del(1p32)

t(4;14) or t(14;16) or t(14;20) 2 among

β2M ≥5.5mg/L

Gain/amp 1q Monoallelic del(1p32)

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Avet-Loiseau et al. J Clin Oncol 2025

(if creat <1.2mg/dL)


What is the Myeloma Treatment Landscape? L O T # 1

Initial Therapy (a.k.a. Frontline, Induction) Quad Therapy (ex. CD38+ MoAb + VRd) HD-Melphalan + Stem Cell Transplant (ASCT)

O r

Consolidation Therapy

Maintenance LOT #2

Treatment for Relapse

LOT #3

Treatment for Relapse

LOT #4

Treatment for Relapse

LOT #5

Treatment for Relapse

LOT #6

Treatment for Relapse

© 2026, International Myeloma Foundation. AllASCT rights =reserved. IMF Stem Confidential Autologous Cell Transplant; MoAb=monoclonal antibody; VRd=Velcade, Revlimid, dexamethasone

Supportive Care and Living Well


Drug Class Overview Class

Drug Name

Abbreviation

IMiD immunomodulatory drug

Thalomid (thalidomide)

T or Thal

Revlimid (lenalidomide)

R, Rev, Len

Pomalyst (pomalidomide)

P or Pom

Velcade (bortezomib)

V or Vel or B

SC/SQ or IV

Kyprolis (carfilzomib)

C or K or Car

IV

Ninlaro (ixazomib)

N or I

Oral

Cytoxan (cyclophosphamide)

C, CTX

Alkeran or Evomela (melphalan)

M or Mel

Oral IV

Decadron (dexamethasone)

Dex or D or d

Prednisone

P or Pred

Monoclonal Antibodies

Darzalex (daratumumab) Sarclisa (isatuximab) Empliciti (elotuzumab)

Dara Isa Elo

IV or SQ IV IV

XPO1 Inhibitors

Xpovio (selinexor)

X or Sel

Oral

Proteasome inhibitor

Chemotherapy

Steroids

© 2026, Myeloma Foundation.Under All rights reserved. IMF= Confidential SCInternational or SQ = Subcutaneous, the skin; IV Intravenous

Administration Oral (PO)

Oral IV


Drug Class Overview Class

Drug Name

Abbreviation

Administration

Peptide Drug Conjugate*

Pepaxto (Melphalan Flufenamide)

Melflufen

IV

BCMA Targeted Antibody Drug Conjugate (ADC)

Blenrep (belantamab mafodotinblmf)

Bela, Belamaf, or B

IV

Abecma (idecabtagene vicleucel)

Ide-cel

CAR T Cell therapy

Bispecific Antibodies

Pipeline

Carvykti (ciltacabtagene vicleucel) Tecvayli (teclistimab) Talvey (Talquetamab) Elrexfio (Elranatamab) Lynozyfic (Linvoseltamab

IV Cilta-cel Tec Talq Elra Linvo

SC/IV

Cevostamab, Iberdomide, Mezigdomide, Anito-cel, Venetoclax AZD0120, Etentamig, KLN-1010, Trispecifics …………………………… TO COME!

MORE

* This agents is currently off the market in the US but available through special programs SC or SQ = Subcutaneous, Under the skin; IV = Intravenous © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


Flow MRD negative*

sCR Response

Myeloma Cells & Protein

Measuring Disease Response: IMWG Response Criteria

Molecular CR CR

VGPR PR MR SD PD

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 Kumar, S., Paiva, B., Anderson, K. C., Durie, B., Landgren, O., Moreau, P., ... & Dimopoulos, M. (2016). International Myeloma Working Group consensus International Myeloma Foundation. All rights reserved. IMF Confidential criteria© for2026, response and minimal residual disease assessment in multiple myeloma. The lancet oncology, 17(8), e328-e346.


When Do I Need A New Treatment? • Not every relapse requires immediate therapy • Each case is different

Asymptomatic biochemical relapse on 2 consecutive assessments

Asymptomatic high-risk disease or rapid doubling time or extensive marrow involvement Consider Treatment Patient-/Disease-Specific Monitor Carefully

Consider Observation Monitor Carefully

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Kumar et al. NCCN Guidelines. Multiple myeloma. V4.2018.

Symptomatic or extramedullary disease

Initiate Treatment


Targets on the Myeloma Cell Surface and Therapeutic AntibodiesBi-Specific Antibodies Bi-Specific Antibodies Talvey (Talquetamab) CAR-T

CAR-T

GPRC5D

FcRH5

SLAMF7

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

Antibody Drug Empliciti (Elotuzumab) Bi-Specific Antibodies

BCMA © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

CD38

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


Antibody Drug Conjugates

How it works: An antibody directed at a target (BCMA) combined with a cytotoxic agent (chemotherapy) ADC = Antibody-Drug Conjugate BCMA = B-Cell Maturation Antigen ADCP/ADCC = Antibody-Dependent Cellular Cytotoxicity & Phagocytosis © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Image Credit: https://creativecommons.org/licenses/by-nc/3.0/

Blenrep (belantamab mafodotin) combinations approved by UK MHRA in relapsed/refractory multiple myeloma. April 2025


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 Tumor Cell Agent T-Cell Target Target

Teclistamab Elranatamab Linvoseltamab

BCMA

CD3

Talquetamab

GPRC5D

CD3

Cevostamab

FcRH5

CD3

“Off the Shelf” Advantage

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 © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

• No manufacturing process, unlike CAR T-cell therapy (but like ADC/belantamab therapy) • Thus, no delay between decision to treat and administration of drug

Image Source: Shah N, et al. Leukemia. 2020;34:985–1005. Creative Commons License: CC BY 4.0. Barilà G, et al. Pharmaceuticals (Basel). 2021;14(1):40.


The Process of CAR T Cell Therapy 1 CAR T therapy recommended. Insurance approved and ready to move forward.

2a

Apheresis to collect T Cells

T Cells

ll e C n T usio f In

3

2b

Bridging therapy, if needed; Lymphodepleting therapy when CAR T cells are ready

CAR Chimeric Antigen Receptor T Cell; LOT =reserved. Lines ofIMF Therapy © T= 2026, International Myeloma Foundation. All rights Confidential

Hucks G, Rheingold SR. Blood Cancer J. 2019;doi:10.1038/s41408-018-0164-6.

4

Close monitoring and Management of side effects

5 HOME!


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

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

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

https://seer.cancer.gov/statfacts/html/mulmy.html dated

 Elimination of disease, down to Minimal Residual Disease Negative (MRD-)  Prolonged deep response Off Therapy  A recent DRAFT definition is being considered:


The Evolution of Myeloma Therapy

Now

VD Rev/Dex CyBorD VTD VRD KRD D-VMP DRD

ASCT Tandem ASCT (?)

Front line treatment

Induction

New

D-VRD Isa-VRD D-KRD Isa-VRD

Consolidation

“More” induction?

Nothing Thalidomide? Bortezomib Ixazomib Lenalidomide Combinations

Idecabtagene autoleucel Ciltacabtagene autoleucel Teclistamab, Talquetamab Elranatamab, Linvoseltamab

Maintenance

Relapsed

Post Consolidation

Rescue

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.

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Bortezomib Panobinostat Lenalidomide Daratumumab Carfilzomib Ixazomib Pomalidomide Elotuzumab Selinexor Isatuximab Belantamab mafodotin* Melphalan flufenamide*

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

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


Where can I learn more? Myeloma.org

Thank you! © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

https://seer.cancer.gov/statfacts/html/mulmy.html; dated 6.15.2024


THE UNSEEN IMPACT OF MYELOMA: TAKING CARE OF YOUR EMOTIONAL HEALTH Yara William, DrPH, MHA IMF Associate Director, Support Groups


THE UNSEEN IMPACT OF MYELOMA: TAKING CARE OF YOUR EMOTIONAL HEALTH IMF Support Group Directors

. .0.2 . .0.2


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

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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.

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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

All feelings are normal! https://opentextbc.ca/introductiontopsychology/chapter/10-1-the-experience-of-emotion/

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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

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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Anger It is completely normal to experience anger towards: •

Doctors

•

Healthcare team

•

Yourself

•

God

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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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.)

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

59


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.

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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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.

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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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

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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Depression Symptoms of depression include: 

Sleep disturbance

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

•

Feelings of guilt or worthlessness

•

Psychomotor disturbance

Changes in energy or excessive • Suicidal thoughts fatigue • Depressed mood • Appetite/weight changes •

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


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

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


Depression is Serious Please take these symptoms seriously AND seek help as you need it! PLEASE call 988 if you ever have thoughts that yo u may want to hurt yourself.

There is a professional available 24/7 to talk with you! © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

65


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.

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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.

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68


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.”

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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.

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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. © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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COPING WITH YOUR EMOTIONS


Coping with Heavy Emotions • Awareness • Identify • Accept • Recognize • Stay Curious • Let go

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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.

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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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

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

75


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 © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

77


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

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

79


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.

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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WELLNESS TIPS & RESOURCES FOR SUPPORT


Support Groups Provide a Sense of Belonging • • • • • • • • • •

Included Welcomed Connected Accepted Involved Supported Heard Valued Seen Hopeful

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


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! © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

83


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

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

84


Follow up Questions or Discussion? Please feel free to reach out to us! IMF Support Group Team: SGTeam@myeloma.org

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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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 California region • Ways to Give • IMF Website © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

88


NAVIGATING INSURANCE & MEDICAL BILLS Susan Yoon, Esq. Triage Cancer


Navigating Insurance & Medical Bills Susan Yoon, Esq. Staff Attorney, Triage Cancer This presentation provides general information on the topics presented. The authors and presenters are not engaged in rendering any legal, medical, or professional services by its presentation or distribution. Although this content was reviewed by a professional, it should not be used as a substitute for professional services. No part of this presentation may be reproduced, distributed, or transmitted in any form or by any means, without the prior written permission of the author, except properly attributed, noncommercial uses permitted by copyright law. For permission requests, contact the authors at info@triagecancer.org © 2026 Triage Cancer®

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About Triage Cancer

Triage Cancer is a national, nonprofit organization that provides free education on the legal and practical issues that may impact individuals diagnosed with cancer and their caregivers. © 2026 Triage Cancer®

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Triage Cancer’s Free Resources

• TriageCancer.org • Educational Events • •

Triage Cancer Conferences Live & Recorded Webinars

• CancerFinances.org • Quick Guides & Checklists • Animated Videos • State Resources & Chart of State Laws • Legal & Financial Navigation Program © 2026 Triage Cancer®

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Don’t Understand Health Insurance? You Are Not Alone.

Source: 2017 PolicyGenius Health Literacy Survey © 2026 Triage Cancer®

94


Terms: Costs Cost to Have Health Insurance • Premium: each month (fixed $ amount)

Costs When You Use Health Insurance • Deductible: each year (fixed $ amount) • Co-Payment: each time you get care (fixed $ amount) • Co-Insurance / Cost-Share: each time you get care (%) • Out-of-Pocket Maximum (fixed $ amount): deductible + co-payments + co-insurance

© 2026 Triage Cancer®

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Meet Michael Michael’s Marketplace Plan:

Deductible = $2,000

Co-insurance = 70/30 plan OOP Max = $8,000 If Michael has a $72,000 hospital bill, what does he pay? 1. His deductible of $2,000 $72,000-$2,000 = $70,000 left 2. His co-insurance amount of 30% 30% of $70,000 = $21,000 But OOP max is $8,000. So, he would pay the $2,000 deductible + $6,000 of the $21,000 co-insurance amount, for a total of $8,000. © 2026 Triage Cancer®

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Out-of-Pocket Maximums Details . . . There may be a separate out-of-pocket maximum for out-of-network services Individual vs. Family Plans • e.g., Individual $5,000 and Family $10,000 Marketplace Plans • Out-of-pocket max = deductible + co-payments + co-insurance (medical care & drugs) Some Employer Plans • Doesn’t include deductibles • Out-of-pocket max = co-payments + co-insurance • Doesn’t include deductibles or co-payments • Out-of-pocket max = co-insurance • Doesn’t include prescription drugs • Separate out-of-pocket max for prescription drugs = co-payments + co-insurance © 2026 Triage Cancer®

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Where We Get Health Insurance All Know Your Health Insurance Options V

© 2026 Triage Cancer®

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Health Insurance Resources TriageCancer.org/HealthInsurance • Quick Guide to Health Insurance Options • Quick Guide to Health Insurance Basics • Quick Guide to Health Insurance Marketplaces • CancerFinances.org  Health Insurance • Triage Cancer Blog – Health Insurance • Recorded Webinar: Understanding Medicare • Recorded Webinar: How to Choose & Use Your Health Insurance …and many more! © 2026 Triage Cancer®

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Comparing Plan Options Marketplace Plan 1

Employer Plan 1

Marketplace Plan 2

Employer Plan 2

Marketplace Plan

Employer Plan © 2026 Triage Cancer®

Medicare Advantage Plan 1

Medicare Advantage Plan 2 100


Total Annual Cost

© 2026 Triage Cancer®

Bronze: Monthly Premium

Deductible

Out-of-pocket Maximum

$200

$6,000

$8,000

Silver: Monthly Premium

Deductible

Out-of-pocket Maximum

$275

$2,500

$6,000

Platinum: Monthly Premium

Deductible

Out-of-pocket Maximum

$400

$0

$2,000 101


Do the Math! Total costs for year = (monthly premium x 12) + OOP max Bronze: Monthly Premium

Deductible

Out-of-pocket Maximum

$200

$6,000

$8,000

$200 x 12 = $2,400 + $8,000 = $10,400 Silver: Monthly Premium

Deductible

Out-of-pocket Maximum

$275

$2,500

$6,000

$275 x 12 = $3,300 + $6,000 = $9,300 Platinum: Monthly Premium

Deductible

Out-of-pocket Maximum

$400

$0

$2,000

$400 x 12 = $4,800 + $2,000 = $6,800 © 2026 Triage Cancer®

Note: for in-network providers only 102


Key Considerations • Cost • Premiums, co-payments, deductibles, co-insurance, out-ofpocket maximums

• Network of providers and facilities • Check if your providers and facilities (hospitals, labs, imaging centers, etc.) are covered

• Prescription drug coverage • Which drugs are covered (i.e., formulary)? • Is there a separate out-of-pocket maximum for drugs? © 2026 Triage Cancer®

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Picking a Health Insurance Plan TriageCancer.org/video-pickingaplan

TriageCancer.org/Worksheet-HealthInsurance © 2026 Triage Cancer®

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TriageCancer.org/Worksheet-Medicare

© 2026 Triage Cancer®

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When to Enroll?

• Employer plans: varies (often in the Fall) • Medicaid: accepted year round • Medicare: Oct. 15 – Dec. 7* • 2027 Marketplace: Nov. 1 – Jan. 15* *Plans are for a calendar year

© 2026 Triage Cancer®

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Where Are There Opportunities to Lower Costs? Insura nce Compa ny Government: Medicare, Medicaid, Military, State & Local Programs, etc.

Employer

© 2026 Triage Cancer®

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Help With COBRA Costs

• Health Insurance Premium Payment Program (HIPP) • Medicaid-eligible recipients with group health insurance • Medicaid pays premium for group health insurance (e.g., COBRA) • Don’t have to change providers; employer coverage may be better • 31 states have this program, including: CA, GA, IA, IL, MA, PA, RI, TX, VA TriageCancer.org/StateLaws

© 2026 Triage Cancer®

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Enhanced Premium Tax Credits “Four in five customers are able to find a plan for $10 or less a month.”

Expired 12/31/2025

Household Size

100%

138%

150%

250%

400%

400% +

1

$15,960

$22,025

$23,475

$39,125

$62,600

2

21,640

29,863

31,725

52,875

84,600

3

27,320

37,702

39,975

66,625

106,600

$ help  reduce monthly premiums to 8.5% of household income

4

33,000

45,540

48,225

80,375

128,600

5

38,680

53,378

56,475

94,125

150,600

6

44,360

61,217

64,725

107,875

172,600

© 2026 Triage Cancer®

(2026)

(2026)

(2025)

(2025)

(2025)

(2025)

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Medicare Part D – 2026

• $2,100 out-of-pocket maximum for Part D drug costs • Applies to: • Part D plans • Part C plans with drug coverage

• Does not apply to drugs covered by Part B!!! • If plan has a drug deductible, that counts towards the out-of-pocket maximum • Cap will continue to increase over time (e.g., $2,400 in 2027)

© 2026 Triage Cancer®

110


Medicare Prescription Payment Plan • Out-of-pocket costs can be spread out through the calendar year (aka “smoothing”) • There is no interest charged on the payments • Run by your Part D drug plan • Voluntary program • You have to choose to sign up • You can cancel at any time, but you must pay your balance

• You pay nothing at the pharmacy • Instead, your plan will send you monthly bills for your out-of-pocket drug costs • This is different than your Part D plan monthly premium bill; and • Your Part D Explanation of Benefits document

• You can pay by check, credit, or debit card © 2026 Triage Cancer®

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Medicare Prescription Drug Exceptions Ask your HCP for supporting statement about why a drug is medically necessary for you •

Alternatives aren’t as effective, and/or

•

Alternatives would cause adverse effects

Timing • Can ask to expedite the request if you can show the standard timeframe will jeopardize life, health, or ability to regain maximum function • After receiving supporting statement, drug plan must provide written notice of decision within 72 hours (24 hours, if expedited request) Appeals • If your request for an exception is denied, appeal! TriageCancer.org/Checklist-MedicarePrescriptionRequest © 2026 Triage Cancer®

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Help Paying for Medicare Parts A & B Medicare savings programs (MSPs) • Helps pay for premiums; and sometimes deductibles, co-payments, & cost-share • Four types of MSPs: 1. Qualified Medicare Beneficiary (QMB – “Quimby”) Program helps eligible individuals pay for Part A and Part B premiums, as well as deductibles, coinsurance, and co-payments 2. Specified Low-Income Medicare Beneficiary (SLMB – “Slimby”) Program helps eligible individuals pay for Part B premiums. 3. Qualifying Individual (QI) Program helps pay the Part B premiums for certain individuals who are not eligible for Medicaid. 4. Qualified Disabled and Working Individuals (QDWI) Program helps eligible individuals pay their Part A premiums.

TriageCancer.org/QuickGuide-MedicareSavings © 2026 Triage Cancer®

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Help Paying for Medicare Part D - 2026 • Low-Income Subsidy (aka Extra Help): most people will pay no premium or deductible & have lower co-payments and cost-share • May be automatically enrolled, but can also apply • Income limit = 150% FPL; Resource limit = $16,590 (individual), $33,100 (married)* • Pay no more than $5.10 for each generic/$12.65 for each brand-name covered drug • www.ssa.gov/benefits/medicare/prescriptionhelp

• State Pharmaceutical Assistance Programs (SPAP): pays some premiums or drug costs • Programs not available in every state: www.medicare.gov/plan-compare/#/pharmaceutical-assistance-program/states/ © 2026 Triage Cancer®

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Consumer Protections: Appeals • Denials of coverage (aka “adverse benefit determination” (ABD)) • Internal appeals • External appeals (individual and employer plans) • AKA: Independent or External Medical Review • Conducted by an independent medical review organization (IRMO) or independent review entity (IRE) • State Health Insurance Agency: Triagecancer.org/StateResources • Cost: $0 if HHS process. Up to $25 if issuer contracts with IRO or uses state process • Is it worth it?

© 2026 Triage Cancer®

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Hurdle: Knowledge

© 2026 Triage Cancer®

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Hurdle: Staying Organized

• Keep track of: • Dates, times, and method of any contact (phone, email, etc.) • Names of people you talk to • Summaries of your conversations • Any documents you send or receive • Important dates

TriageCancer.org/AppealTrackingForm

• Good time to delegate to family and friends © 2026 Triage Cancer®

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Appeals Checklist  Understand why your claim was denied  Gather your evidence  Submit necessary paperwork  Pay attention to deadlines  Remember the Golden Rule  File external appeal if needed  Expedite appeal if appropriate  Stay organized  Don’t give up! © 2026 Triage Cancer®

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Health Insurance Appeals Resources TriageCancer.org/HealthInsurance

• Quick Guide to Appeals for Employer-Sponsored & Individual Health Insurance • Quick Guide to Access to Medical Records • Health Insurance Appeals Tracking Form • CancerFinances.org – Health Insurance Appeals Module • Recorded Webinar: Health Insurance Appeals • Animated Video: When an Insurance Company Says No

© 2026 Triage Cancer®

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Managing Medical Bills • From your insurance company: We have received a claim

© 2026 Triage Cancer®

We are processing your claim

Explanation of Benefits

120


© 2026 Triage Cancer®

121


Managing Medical Bills

• From your provider: • The bill

• Doesn’t always happen in this order! • • • • •

Wait for the EOB before paying any bills Compare EOB & Bills – check for errors! Ask questions of providers and insurance Was coverage denied? Appeal! Do you qualify for hospital charity care?

© 2026 Triage Cancer®

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Charity Care

• Nonprofit hospitals are required to offer free or discounted health care to patients with certain incomes • A/K/A financial assistance or ability to pay programs • Can include inpatient and emergency room services • Bill shouldn’t go to collections while application under review • Apply for help from Dollar For: DollarFor.org/TriageCancer

© 2026 Triage Cancer®

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Negotiate! • Contact providers if having trouble paying your bills • When: • Before unpaid bills sent to collections agencies

• What: • Ask for more time • Check to see if they would be willing to: • Write off a portion of your bill; • Negotiate a payment plan; or • Accept a lower lump sum payment Note: can work with other creditors, too! © 2026 Triage Cancer®

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Medical Bill Tracker TriageCancer.org/Worksheet-BillTracker

© 2026 Triage Cancer®

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© 2026 Triage Cancer®

126


Benefits to Keeping Track . . .

• Paying co-pays & co-insurance when you visit a provider • What to do if you have already met your OOP maximum? • What to do when a provider asks you to pre-pay your co-insurance?

© 2026 Triage Cancer®

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Keep Records Of…  Medical bills from all healthcare providers:  Hospital admissions, clinic visits, lab work, diagnostic tests, procedures, treatments  Drugs given & prescriptions ordered  Claims filed

 Payments from insurance companies and explanations of benefits  Any pre-authorizations  Dates, names, and outcomes of any correspondence with insurance companies or providers  Non-reimbursed or outstanding medical and related costs  Meals, lodging, and travel expenses (including gas, parking, and tolls)  Your medical records *Some of these may be tax-deductible! © 2026 Triage Cancer®

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Triage Cancer Conference Educational event for: • Individuals diagnosed with chronic or serious medical conditions • Caregivers Online 2026: • Health care teams • May 15-16 • Advocates & others • November 6-7 Topics: • Being an Advocate TriageCancer.org/Conferences • Health Insurance • Finances “Absolutely amazing. Triage Cancer Conference supplied me with a lot of details on information that I thought I • Being Prepared knew....I was wrong. However, I do feel more confident in • Employment each of the topics that were discussed.” –Virtual Attendee • Disability Insurance *Free CEs/Contact Hours for nurses, social workers, & patient advocates *Free PDCs for HR professionals © 2026 Triage Cancer®

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Webinar Series Upcoming Topics: • August 26 ~ Ready to Return: Understanding Your Rights When Going Back to Work • September 16 ~ Understanding Changes to Medicaid & the Marketplace: What Health Advocacy Organizations Need to Know • September 22 ~ Open Enrollment: Reviewing, Reevaluation, Renewing Full Schedule & Registration: TriageCancer.org/Webinars Recordings of Past Webinars: TriageCancer.org/Past-Webinars *Free Contact Hour/CE for nurses, social workers, & patient advocates *Free PDCs for HR professionals © 2026 Triage Cancer®

“It is helpful to know this info at the beginning of a cancer diagnosis or at the VERY LEAST to know it exists, as you do not know what you do not know!” –Attendee

130


Legal & Financial Navigation Program Free, one-on-one help for: • Individuals diagnosed with cancer • Caregivers • Health care professionals

Health Insurance, Employment, Disability Insurance, Finances, Estate Planning, & More Our Navigation services: • Explain options • Provide accurate information • Empower you to take next steps

© 2026 Triage Cancer®

Start Online: TriageCancer.org/GetHelp For Spanish: TriageCancer.org/ConsigueAyuda 131


2026 MYELOMA ADVOCACY PRIORITIES & HOW YOU CAN GET INVOLVED Danielle Hillwig Doheny IMF Director of Public Policy & Advocacy


2026 Myeloma Advocacy Priorities & How You Can Get Involved Danielle Hillwig Doheny IMF, Director of U.S. Policy & Advocacy


Introduction | Advocacy at the IMF The IMF Advocacy Team collaborates with multiple stakeholders to inform and influence decision-making on the critical healthcare issues that directly impact myeloma patients.

The U.S. Advocacy Team advocates for equitable access to timely diagnosis, innovative treatments and research funding on Capitol Hill and with key regulatory agencies. The team advocates both alongside of and on behalf of the patient community that we serve.

Advocacy play a critical role to educate policymakers about the issues important to our community and motivate them to act.


What Do We Advocate For? The following policy principles are the foundation on which we prioritize our advocacy work. 1. Ensure Access to Care: We advocate for policies that ensure all myeloma patients have equitable, comprehensive, patientcentered care without insurance barriers that limit options or delay treatment initiation. 2. Eliminate Financial Barriers: We advocate for policies that allow myeloma patients access to treatments and supportive care interventions without facing financial hardships. 3. Advance Myeloma Research: We advocate for annual appropriations funding for myeloma research and the advancement of clinical trial eligibility and research protocols that ensure representation from diverse populations.


2026 U.S. Advocacy Priorities Snapshot 1. ENSURE ACCESS TO CARE

INSURANC E REFORM: DRUG ACCESS INSURANC E REFORM: DRUG ACCESS MEDICARE REFORM: PHYSICIAN ACCESS

Step Therapy Protocols Safe Step Act

PBM Reform PBM Reform Act

2. ELIMINATE FINANCIAL BARRIERS

INSURANC E REFORM: COINSURANCE

INSURANC E REFORM:

3. ADVANCE MYELOMA RESEARCH Annual Appropriations

Oral Parity Cancer Drug Parity Act FEDERAL FUNDING

Copay Accumulators HELP Copays Act

ANNUAL APPROPS

COPAYS

Tele-Health/Medicine Telehealth Modern. Act

MEDICARE REFORM: ANNUAL COST LIMITS

Inflation Reduction Act implementation Cap & Smoothing (MPPP), Drug Pricing, Drug Formularies

CLINICAL TRIAL ACCESS

NIH: National Cancer Institute, National Institute on Minority Health, ARPA-H CDC: Comprehensive Cancer Control Initiative DoD: Congressionally Directed Medical Research Program (CDMRP) for Myeloma. Primary care education, Focus on underserved, POC, rural settings and socioeconomically disadvantaged groups


How You Can Get Involved

Patients and caregivers are the most powerful voices in health policy. 13 7


Your Voice Matters in Washington, D.C. WHAT THIS IS: Each year, the International Myeloma Foundation brings myeloma patients and caregivers to Capitol Hill to meet with members of Congress. Together, we advocate for: • Better access to treatment • Stronger support for cancer research • Policies that improve the lives of people living with myeloma

HOW YOU CAN GET INVOLVED: No policy experience is needed. Just a willingness to share your experience. IMF provides: • Advocacy training • Policy briefings • Guidance every step of the way Email us to join the IMF Advocacy Master Class and prepare for the next Hill Day.

13 8


Advocacy Works: Protecting Cancer Research Funding Program

President’s FY26 Budget Proposal

Final FY26 Funding Outcome

NIH

-$18 billion cut proposed

+$415 million increase

NCI

-$2.7 billion cut proposed

+$128 million increase

ARPA-H

-$545 million cut proposed

Level funding

CDC Cancer Programs

Program eliminated

+$3 million increase

13 9


Myeloma Action Month Hill Day 2026

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” — Margaret Mead 14 0


Addressing healthcare barriers for multiple myeloma patients depends on winning over the hearts and minds of policymakers. It is not enough to just identify an issue and have data-driven evidence/research to back it up. It is not even enough to work with coalition partners that agree with our point of view. We must convince policymakers to prioritize our issues, draft legislation and vote it into law. Email us at advocacy@myeloma.org Join Us! Join the Advocacy Team and share Your Story.


Thank You


MYELOMA 202: IMMUNOTHERAPY MADE SIMPLE Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO IMF Medical Advisor


MYELOMA 202: IMMUNOTHERAPY MADE SIMPLE


 Discuss the concept of

immunotherapy and how it applies to myeloma

 Review how we are using

immunotherapy already in myeloma

OBJECTIVES

   

Monoclonal Antibodies Antibody Drug Conjugates (ADCs) CAR (Chimeric Antigen Receptor) T Cell therapy Bispecific/Trispecific Antibodies

 Predict the future of myeloma

and its reliance on immunotherapy…


The Immune System and Cancer

J Clin Invest. 2007 May 1; 117(5): 1137–1146.

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


Uhhhhh it’s complicated…. Myeloma Cell tic opto p a i Ant Effects

Myeloma Cell NFkB Site ing Bind

NFkB AKT MAPK

JAK–STAT

Increase in cytokine production and adhesion molecules

SHP2

NFkB–IkB complex

MEK

IL-6 TNFα

Cell organelles

cFLIP

FAS (CD95)

Pro-caspase B

cFLIP/FADD

Protein kinases

SDF1 IGF1

Block of programmed cell death FADD LFA1

FAS ligand Collagen fibers

VLA4 VCAM1

T Cells Fibronectin

MEK/MAPK

VEGF

NFkB–IkB complex

NFkB Binding Site

NFkB

BM Stromal Cells Angiogenesis Migration Growth

Natural-Killer Cells

TNFα

Inhibition of Anti-Myeloma Immunity Dendritic Cells Bruno B et al. Lancet Oncol. 2004;5:430-442.

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Monocytes


Key Immunotherapy Approaches in Myeloma Monoclonal Antibodies 

Daratumumab, Elotuzumab, Isatuximab

Antibody-Drug Conjugates 

Belantamab

CAR T cell therapy 

Ide-cel, cilta-cel

Bispecific Antibodies 

Teclistamab, Talquetamab, Elranatamab, Linvoseltamab

Future Directions – MORE antibodies, novel CAR T and much more! © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


Immunotherapy: Using Your Immune System to Fight MM

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


Targets on the Myeloma Cell Surface and Therapeutic Antibodies Bi-Specific Antibodies CAR-T

Bi-Specific Antibodies Talvey (Talquetamab) CAR-T

GPRC5D

FcRH5

SLAMF7

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

Antibody Drug Empliciti (Elotuzumab) Bi-Specific Antibodies

BCMA © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

CD38

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


Antibody Drug Conjugates

How it works: An antibody directed at a target (BCMA) combined with a cytotoxic agent (chemotherapy) ADC = Antibody-Drug Conjugate BCMA = B-Cell Maturation Antigen ADCP/ADCC = Antibody-Dependent Cellular Cytotoxicity & Phagocytosis © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Image Credit: https://creativecommons.org/licenses/by-nc/3.0/


CAR T Cell Therapy

Myeloma Cell CAR T Cell .

CAR T Cell Therapy

Abecma (Idecabtagene vicleucel)

Ide-cel

Carvykti (ciltacabtagene autoleucel)

cilta-cel

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Intravenous


Harnessing the Power of a Patient’s Own Immune System to Target and Kill Myeloma

Apheresis

ENGINEERED AUTOLOGOUS CELL THERAPY

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Manufacturing Process

Infusion


The Process of CAR T Cell Therapy

Hucks G, Rheingold SR. Blood Cancer J. 2019;doi:10.1038/s41408-018-0164-6. © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


Toxicities with CAR T Cell Therapy Early Long-term Delayed

(Days/Weeks)

(Weeks/Months)

(Years)

Cytokine Release Syndrome (CRS) Neurotoxicity (ICANS)

Delayed neurotoxicity (Parkinsonism, cranial nerve palsy)

Secondary Cancers

IEC-Colitis

Unknown long-term effects

IEC-HS Cytopenias and infections ICANS = immune effector cell-associated neurotoxicity syndrome IEC = immune effector cell © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


The Future of CAR T Cell Therapy Novel CAR Ts with unique features non BCMA targets (GPRC5D, FcRH5 and others)  “fast Cars” with shorter manufacturing time  enhanced binding 

 

dual targeting d-domain binding

in vivo CAR T – without the need of T cell collection or lymphodepleting chemotherapy Allo-CAR T – external T cells infused into the patient

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


Bispecific Antibodies – BCMA • 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 • BCMA = B Cell Maturation Antigen

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

157


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 Agent

Tumor Cell Target

T-Cell Target

Teclistamab Elranatamab Linvoseltamab

BCMA

CD3

Talquetamab

GPRC5D

CD3

Cevostamab

FcRH5

CD3

“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 © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

Image Source: Shah N, et al. Leukemia. 2020;34:985–1005. Creative Commons License: CC BY 4.0. Barilà G, et al. Pharmaceuticals (Basel). 2021;14(1):40.


The Future of Bispecific Antibodies Novel targets 

FcRH5 (Cevostamab)

More convenient dosing 

monthly (Etentamig)

Trispecific Antibodies 

dual MM Cell targeting – potential for enhanced binding and less resistance

Combinations with other MM agents (TeclistamabDaratumumab) © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


Conclusions •

Immunotherapy has completely transformed cancer care

•

In MM we have several forms of immunotherapy already approved and many many more to come

•

There may be a day when immunotherapy may replace traditional induction therapy and stem cell transplant

•

The next wave of immunotherapy will be likely MORE effect and have LESS side effects

•

The IMF houses the immunotherapy database so we can learn more about this treatment even more quickly

© 2026, International Myeloma Foundation. All rights reserved. IMF Confidential


UNDERSTANDING CLINICAL TRIALS Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO IMF Medical Advisor


THE 5 W’S OF CLINICAL TRIALS IN MYELOMA

WHAT? WHY? WHO? WHEN? WHERE?

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Q&A WITH GUEST PANEL


Please Join us now for the Welcome Reception In the Courtyard Outside

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TOMORROW MORNING:

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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 California region • Ways to Give • IMF Website © 2026, International Myeloma Foundation. All rights reserved. IMF Confidential

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THANK YOU TO OUR SPONSORS!

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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.


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