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Case Challenges in Newly Diagnosed Multiple Myeloma

  • Authors: Sandy Wong, MD
  • CME / ABIM MOC Released: 3/17/2023
  • Valid for credit through: 3/17/2024
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for community-based hematologists/oncologists.

The goal of this activity is for learners to be better able to evaluate patients with newly diagnosed MM and select appropriate therapy in this setting.

Upon completion of this activity, participants will:

  • Have greater competence related to
    • Selecting optimal, individualized first-line therapy in patients with newly diagnosed MM
    • Assessing risk status in patients with MM
    • Managing adverse events associated with therapy for MM
  • Demonstrate greater confidence in their ability to
    • Select personalized therapy for patients with newly diagnosed MM


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All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

Disclosures for additional planners can be found here.


  • Sandy Wong, MD

    Associate Professor
    Division of Hematology/Oncology
    Helen Diller Family Comprehensive Cancer Center
    University of California, San Francisco
    San Francisco, California


    Sandy Wong, MD, has the following relevant financial relationships:
    Consultant or advisor for: Catalent Biologics; Dren Biosciences; Sanofi
    Research funding from: Bristol Myers Squibb Company; Caleum; Fortis; Genentech; GlaxoSmithKline; Janssen; Patient Discovery


  • Megan Whitney, DMD

    Medical Education Director, Medscape, LLC 


    Megan Whitney, DMD, has no relevant financial relationships. 

  • Tristin Abair, PhD

    Senior Medical Writer, Medscape, LLC 


    Tristin Abair, PhD, has no relevant financial relationships. 

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

Accreditation Statements

In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
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Case Challenges in Newly Diagnosed Multiple Myeloma

Authors: Sandy Wong, MDFaculty and Disclosures

CME / ABIM MOC Released: 3/17/2023

Valid for credit through: 3/17/2024



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  2. National Comprehensive Cancer Network Guidelines in Oncology (NCCN Guidelines®). Multiple myeloma (Version 3.2023). 2023. Accessed December 8, 2022.
  3. Palumbo A, et al. Revised international staging system for multiple myeloma: a report from International Myeloma Working Group. J Clin Oncol. 2015;33:2863-2869.
  4. Milani P, et al. Serum-free light-chain analysis in diagnosis and management of multiple myeloma and related conditions. Scand J Clin Lab Invest Suppl. 2016;245:S113-S118.
  5. Bolli N, et al. Next-generation sequencing for clinical management of multiple myeloma: ready for prime time? Front Oncol. 2020;10:189.
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  7. Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. Am J Hematol. 2022;97:1086-1107.
  8. Hanamura I. Multiple myeloma with high-risk cytogenetics and its treatment approach. Int J Hematol. 2022;115:762-777.
  9. Keats JJ, et al. In multiple myeloma, t(4;14)(p16;q32) is an adverse prognostic factor irrespective of FGFR3 expression. Blood. 2003;101:1520-1529.
  10. Attal M, et al. Lenalidomide, bortezomib, and dexamethasone with transplantation for myeloma. N Engl J Med. 2017;376:1311-1320.
  11. Ricciuti G, et al. Autologous stem cell transplantation in multiple myeloma. Panminerva Med. 2020;62:220-224.
  12. Perrot A, et al. Early versus late autologous stem cell transplant in newly diagnosed multiple myeloma: long-term follow-up analysis of the IFM 2009 trial. Blood. 2020;136: Abstract 39.
  13. Richardson PG, et al. Triplet therapy, transplantation, and maintenance until progression in myeloma. N Engl J Med. 2022;387:132-147.
  14. Roussel M, et al. Up-front carfilzomib, lenalidomide, and dexamethasone with transplant for patients with multiple myeloma: the IFM KRd final results. Blood. 2021;138:113-121.
  15. Landgren O, et al. Efficacy and safety of carfilzomib-lenalidomide-dexamethasone in newly diagnosed multiple myeloma: pooled analysis of four single-arm studies. Leuk Lymphoma. 2022;63:2413-2421.
  16. Gay F, et al. Carfilzomib with cyclophosphamide and dexamethasone or lenalidomide and dexamethasone plus autologous transplantation or carfilzomib plus lenalidomide and dexamethasone, followed by maintenance with carfilzomib plus lenalidomide or lenalidomide alone for patients with newly diagnosed multiple myeloma (FORTE): a randomised, open-label, phase 2 trial. Lancet Oncol. 2021;22:1705-1720.
  17. Mina R, et al. Carfilzomib induction, consolidation, and maintenance with or without autologous stem-cell transplantation in patients with newly diagnosed multiple myeloma: pre-planned cytogenetic subgroup analysis of the randomised, phase 2 FORTE trial. Lancet Oncol. 2023;24:64-76.
  18. Moreau P, et al. Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study [published correction appears in Lancet. 2019 Jun 14;:]. Lancet. 2019;394:29-38.
  19. Voorhees PM, et al. Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma: the GRIFFIN trial. Blood. 2020;136:936-945.
  20. Chari A, et al. Daratumumab plus lenalidomide, bortezomib, and dexamethasone (D-RVd) in transplant-eligible newly diagnosed multiple myeloma (NDMM) patients (Pts): final analysis of Griffin among clinically relevant subgroups. Blood. 2022;140: Abstract 3238.
  21. A phase 3 study comparing daratumumab, velcade (bortezomib), lenalidomide, and dexamethasone (D-VRd) vs velcade, lenalidomide, and dexamethasone (VRd) in subjects with previously untreated multiple myeloma who are eligible for high-dose therapy. Accessed February 3, 2021.
  22. Landgren O, et al. Safety and effectiveness of weekly carfilzomib, lenalidomide, dexamethasone, and daratumumab combination therapy for patients with newly diagnosed multiple myeloma: the MANHATTAN nonrandomized clinical trial. JAMA Oncol. 2021;7:862-868.
  23. Costa LJ, et al. Daratumumab, carfilzomib, lenalidomide, and dexamethasone with minimal residual disease response-adapted therapy in newly diagnosed multiple myeloma. J Clin Oncol. 2022;40:2901-2912.
  24. Carfilzomib [prescribing information]. Approved 2012. Revised June 2022.
  25. Paul B, et al. Daratumumab subcutaneous formulation for the treatment of multiple myeloma. Expert Opin Biol Ther. 2020;20:1253-1259.
  26. Rajkumar SV, et al. Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol. 2010;11:29-37.
  27. Kumar S, et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016;17:e328-e346.
  28. Nadeem O, et al. The safety of current and emerging therapies for multiple myeloma. Expert Opin Drug Saf. 2020;19:269-279.
  29. Piedra K, et al. Comparison of venous thromboembolism incidence in newly diagnosed multiple myeloma patients receiving bortezomib, lenalidomide, dexamethasone (RVD) or carfilzomib, lenalidomide, dexamethasone (KRD) with aspirin or rivaroxaban thromboprophylaxis. Br J Haematol. 2022;196:105-109.
  30. Lenalidomide [prescribing information]. Approved 2005. Revised May 2022.
  31. Pawlyn C, et al. Lenalidomide-induced diarrhea in patients with myeloma is caused by bile acid malabsorption that responds to treatment. Blood. 2014;124:2467-2468.
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  33. Durie BGM, et al. Longer term follow-up of the randomized phase III trial SWOG S0777: bortezomib, lenalidomide and dexamethasone vs. lenalidomide and dexamethasone in patients (Pts) with previously untreated multiple myeloma without an intent for immediate autologous stem cell transplant (ASCT). Blood Cancer J. 2020;10:53.
  34. O'Donnell EK, et al. A phase 2 study of modified lenalidomide, bortezomib and dexamethasone in transplant-ineligible multiple myeloma. Br J Haematol. 2018;182:222-230.
  35. Facon T, et al. Daratumumab plus lenalidomide and dexamethasone for untreated myeloma. N Engl J Med. 2019;380:2104-2115.
  36. Facon T, et al. Daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone alone in newly diagnosed multiple myeloma (MAIA): overall survival results from a randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22:1582-1596.
  37. Facon T, et al. Daratumumab plus lenalidomide and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: frailty subgroup analysis of MAIA. Leukemia. 2022;36:1066-1077.
  38. Mateos MV, et al. Overall survival with daratumumab, bortezomib, melphalan, and prednisone in newly diagnosed multiple myeloma (ALCYONE): a randomised, open-label, phase 3 trial. Lancet. 2020;395:132-141.
  39. Yimer H, et al. Daratumumab, cyclophosphamide, bortezomib, and dexamethasone for multiple myeloma: final results of the LYRA study. Leuk Lymphoma. 2022;63:2383-2392.
  40. Kumar SK, et al. Carfilzomib or bortezomib in combination with lenalidomide and dexamethasone for patients with newly diagnosed multiple myeloma without intention for immediate autologous stem-cell transplantation (ENDURANCE): a multicentre, open-label, phase 3, randomised, controlled trial. Lancet Oncol. 2020;21:1317-1330.
  41. Facon T, et al. Oral ixazomib, lenalidomide, and dexamethasone for transplant-ineligible patients with newly diagnosed multiple myeloma. Blood. 2021;137:3616-3628.
  42. Daratumumab [prescribing information]. Approved 2020. Revised November 2022.
  43. Moore DC, et al. Evaluation of montelukast for the prevention of infusion-related reactions with daratumumab. Clin Lymphoma Myeloma Leuk. 2020;20:e777-e781.
  44. Coffman K, et al. Daratumumab infusion reaction rates pre- and post-addition of montelukast to pre-medications. J Oncol Pharm Pract. 2023;29:333-337.
  45. Jackson GH, et al. Lenalidomide maintenance versus observation for patients with newly diagnosed multiple myeloma (Myeloma XI): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2019;20:57-73.
  46. McCarthy PL, et al. Lenalidomide maintenance after autologous stem-cell transplantation in newly diagnosed multiple myeloma: a meta-analysis. J Clin Oncol. 2017;35:3279-3289.
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