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CME: Updates in multiple myeloma (MM): Determining next steps forward in the face of relapse


Activity Description / Statement of Need:

In this online, self-learning activity:

Multiple myeloma (MM) is a hematologic malignancy of the lymphocytes, and while the true cause is unknown, associated factors are thought to include: radiation, genetics, viral infections, and the human immunodeficiency virus. Myeloma is most common of the hematologic malignancies after non-Hodgkin lymphoma, with an incidence of over 34,000 and an annual mortality rate of over 12,000. The peak incidence age of MM is at about 70 years of age, and the disease occurs twice as commonly in African Americans as it does in whites.

Goals of care in MM are prolonging survival rates and improving quality of life, and treatment begins with induction and post-induction therapy, followed by hematopoietic stem cell transplant or maintenance therapy in patients ineligible for transplant. Relapse is indicated by any of several clinical signs, including new soft tissue plasmacytomas, hypercalcemia, renal insufficiency, anemia, new bone lesions, or hyperviscosity related to serum paraprotein.

Target Audience:

Hematologists and oncologists; physician assistants, nurse practitioners, and pharmacists who practice in oncology; and any other healthcare professionals with an interest in or who clinically encounter patients with RRMM.

Commercial Support Disclosure: This program is supported by an educational grant from Takeda.

This activity is free of charge.

Release Date: October 08, 2022 -- Expiration Date: October 08, 2023

Faculty: Scott Goldsmith, MD


Faculty introduction, disclosures

Introduction content

  • Statistics and risk stratification
  • MM treatment paradigm

Updates in treatment and monitoring of patients with RRMM

  • Treatment history and therapeutic objectives

·      Present pharmacotherapy, clinical trial findings, and guideline updates

o   Treatment of first relapses

§  Lenalidomide sensitive

§  Treatment options when refractory to:

·       Lenalidomide alone

·       Lenalidomide and bortezomib

·       Lenalidomide and daratumumab

o   Treatment of later relapses

§  Regimens including agents to which the patient’s disease is not already refractory: pomalidomide, carfilzomib, isatuximab, elotuzumab, ixazomib, selinexor

§  Penta-refractory disease

·       Therapy aimed at B cell maturation antigen (BCMA) via chimeric antigen receptor T cell (e.g., idecabtagene vicleucel or ciltacabtagene autoleucel) or antibody conjugate (e.g., belantamab mafodotin) therapy

·       Nuclear export inhibition

·       Alkylator-containing regimens

·       Investigational therapies targeting: Bcl-2; Bruton tyrosine kinase; BCMA

·       Disease response and relapse monitoring

o   Timing

o   Assessment: serum protein electrophoresis, 24-hour urine protein electrophoresis, free light chain assay, and minimum residual disease

·       Additional considerations and challenges

o   Treatment-emergent adverse effects and their management

o   Other patient-related factors: age-related frailty, acute renal failure, extramedullary disease

o   Pandemic-related considerations

o   Patient education, shared decision-making, and patient-reported outcomes

o   Disparities in care

  • Patient cases

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Describe guideline-recommended therapy for RRMM.
  • Recall first- and later-line pharmacotherapies for RRMM.
  • Describe emerging treatment options presently available for RRMM, their mechanisms of action and safety, and anticipated place in therapy.
  • Summarize the healthcare burden unique to patients with RRMM and related challenges to effective disease management.
  • Develop a treatment plan for a patient with RRMM.


ACCME Activity #202340979


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by ScientiaCME.

Faculty DisclosureScott Goldsmith, MD, Assistant Professor, Division of Myeloma, City of Hope National Medical Center, has received financial compensation from Janssen, Sanofi-Genzyme, Wugen, Adaptive Biosciences, and Oncovalent for consulting and/or advisory board work.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty will discuss off-label uses.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from Takeda.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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