Adekola, Kehinde

The treatment landscape for multiple myeloma (MM) is evolving rapidly and includes several new options. The management must be tailored to the individual. The NCCN Guidelines for MM provide a framework to base decisions regarding diagnosis, workup, treatment, and follow-up of both newly diagnosed and previously treated relapsed/refractory MM. This manuscript outlines the recommendations from NCCN Guidelines for MM specific to newly diagnosed MM (NDMM).

The NCCN Guidelines for Multiple Myeloma (MM) provide recommendations for diagnosis, initial workup, treatment, follow-up, and supportive care for patients with MM. These NCCN Guidelines Insights highlight the important updates and changes specific to systemic therapy for patients with newly diagnosed as well as previously treated MM included in Version 1.2025 of the NCCN Guidelines for MM.

Introduction: Health disparities negatively impact outcomes of patients (pts) with hematologic malignancies. Limited retrospective data correlating health disparities with lymphoma outcomes prohibit proper identification of reversible causes and elaboration of potential interventions. We present data from a coordinated effort between the National Clinical Trials Network (NCTN) cooperative groups (Alliance for Clinical Trials in Oncology [Alliance], Eastern Cooperative Oncology Group [ECOG], and the Southwest Oncology Group [SWOG]) to catalog the racial, ethnic, and socioeconomic characteristics of pts with lymphoma to better understand the quality of data collected, analyze selected health disparity indicators, and develop a prospective data collection tool. Methods: We conducted a retrospective analysis of demographic data from pts with lymphoma enrolled on 32 cooperative group therapeutic trials between 2005 and 2020. Special focus was placed on data regarding race, ethnicity, and proxies that help identify socioeconomic status (health insurance, residential zip code, Social Deprivation Index [SDI]). These were evaluated in relation to histology-based metrics from the Surveillance, Epidemiology, and End Results Program (SEER) Program with reported data through 2022. Here, our focus is to characterize baseline demographic and disparities data on the collection of these 32 NCTN lymphoma trials. Results: A total of 3,897 pts were included, with 3,406 non-Hodgkin lymphoma (87.4%) - 1,644 diffuse large B-cell (DLBCL, 48.3%), 905 follicular (26.6%), 669 mantle cell (19.6%), 113 primary central nervous system (3.3%), 75 T-cell (2.2%) - and 491 Hodgkin lymphoma (12.6%). Age at registration was available for 3,891 pts with median age 57.1 years (range: 18-92). The majority of patients were male (58.8%; one pt missing biological sex data). Race data were available for all but one patient, where most pts were white (W, 86.6%), followed by 246 African American (AA, 6.3%), 99 Asian (A, 2.5%), 13 American Indian or Alaska Native (AI, 0.3%), 8 Native Hawaiian or Pacific Islander (PI, 0.2%), 11 with more than 1 race reported (0.3%), and 145 with unknown/not reported race. Ethnicity data were unknown for 327 pts (8.4%) with 179 Hispanic or Latino (Hisp, 4.6%). Combined race/ethnicity data showed 3,010 non-Hisp white (NHW, 77.2%) and 219 non-Hisp black (NHB, 5.6%). For comparison, in the SEER database, 84.7% of all lymphoma cases were W, with 8.6% AA, 5.2% A/PI, 0.4% AI, and 1.1% unknown race, and with 13.9% of pts reported as Hisp. When focusing on the 804 pts enrolled on Alliance CALGB 50303 and ECOG-ACRIN 1412 studies, two randomized DLBCL studies, there was a more proportional representation of W and AA pts with DLBCL - 82.1% and 9.8% compared 84.6% and 7.7%, respectively, at SEER database, with 5.3% Hisp (with another 5.3% unknown) compared to 14.9% at SEER. Insurance information was missing in 113 pts. Of the remainder, 2,102 pts had private insurance only (55.6%), 549 with a mix of private and public (14.5%), 701 public only (18.5%, including 11.4% Medicare, 4.5% Medicaid, 0.8% both), and 166 self-pay (4.4%). Year-matched SDI score was available in 2,885 pts, where higher SDI scores = higher social deprivation. The total mean SDI score for the overall cohort was 42.5 with significant differences observed based on race/ethnicity and insurance type. Specifically, NHW were from less deprived areas (mean SDI=38.8) than NHB (66.4) or Hisp (65.5) (p<0.0001). Those without insurance (mean SDI=52.6) or only public insurance (48.9) were located in areas associated with greater deprivation compared to pts with private (40.1) or public+private (38.8) insurance (p<0.0001). Conclusion: To our knowledge, this is the largest retrospective catalog of racial, ethnic, and socioeconomic characteristics of pts with lymphoma enrolled on cooperative group therapeutic trials. The scope of NCTN cooperative group lymphoma studies provides a unique opportunity to assess novel therapeutic outcomes for patients representing racial, ethnic and socioeconomic subgroups with both common and rare lymphoma subtypes. From this resource, additional analyses on relationships between SDI, race/ethnicity, insurance coverage, disease subtype, and temporal trends will be presented. Support: U10CA180821, U10CA180882, UG1CA189823

The treatment of Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) has evolved to include several new options. The NCCN Guidelines for WM/LPL provide a framework on which to base decisions regarding diagnosis, treatment, assessment of response to treatment, and follow-up of both newly diagnosed and previously treated WM/LPL.

The treatment of relapsed/refractory multiple myeloma (MM) has evolved to include several new options. These include new combinations with second generation proteasome inhibitors (PI); second generation immunomodulators, monoclonal antibodies, CAR T cells, bispecific antibodies, selinexor, venetoclax, and many others. Most patients with MM undergo several cycles of remissions and relapse, and therefore need multiple lines of combination therapies. Selecting treatment options for relapsed/refractory MM requires consideration of resistance status to specific classes, and patient-specific factors such as age and other comorbidities should be considered. The NCCN Guidelines for MM provide a framework on which to base decisions regarding workup, treatment, and follow-up of newly diagnosed and previously treated MM. This manuscript outlines the recommendations from NCCN Guidelines for MM specific to relapsed/refractory disease.

Abstract Graft-versus-host disease (GVHD) of the gastrointestinal (GI) tract is the main cause of nonrelapse mortality (NRM) after allogeneic hematopoietic cell transplantation. Ann Arbor (AA) scores derived from serum biomarkers at onset of GVHD quantify GI crypt damage; AA2/3 scores correlate with resistance to treatment and higher NRM. We conducted a multicenter, phase 2 study using natalizumab, a humanized monoclonal antibody that blocks T-cell trafficking to the GI tract through the α4 subunit of α4β7 integrin, combined with corticosteroids as primary treatment for patients with new onset AA2/3 GVHD. Seventy-five patients who were evaluable were enrolled and treated; 81% received natalizumab within 2 days of starting corticosteroids. Therapy was well tolerated with no treatment emergent adverse events in >10% of patients. Outcomes for patients treated with natalizumab plus corticosteroids were compared with 150 well-matched controls from the MAGIC database whose primary treatment was corticosteroids alone. There were no significant differences in overall or complete response between patients treated with natalizumab plus corticosteroids and those treated with corticosteroids alone (60% vs 58%; P = .67% and 48% vs 48%; P = 1.0, respectively) including relevant subgroups. There were also no significant differences in NRM or overall survival at 12 months in patients treated with natalizumab plus corticosteroids compared with controls treated with corticosteroids alone (38% vs 39%; P = .80% and 46% vs 54%; P = .48, respectively). In this multicenter biomarker–based phase 2 study, natalizumab combined with corticosteroids failed to improve outcome of patients with newly diagnosed high-risk GVHD. This trial was registered at www.clinicaltrials.gov as # NCT02133924.

The NCCN Guidelines for Multiple Myeloma provide recommendations for diagnosis, initial workup, treatment, follow-up, and supportive care for patients with various plasma cell neoplasms, including multiple myeloma. These NCCN Guidelines Insights highlight some of the important updates/changes specific to the treatment of patients with multiple myeloma in the 2022 version of the guidelines.

Multiple myeloma is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. This manuscript discusses the management of patients with solitary plasmacytoma, smoldering multiple myeloma, and newly diagnosed multiple myeloma.

Key Points Over the last decade, allogeneic HCT has been increasingly administered in the United States to adults aged 70 and older with hematologic malignancies. Allogeneic transplant outcomes were reasonable; high comorbidity and ablative conditioning regimens were associated with inferior outcomes.