FEATURE
Features
Order
Matters:
The Art and
Science of
Myeloma Drug
Sequencing
Examining the who, what,
when, where, and why of
myeloma treatment
I
n 1844, Thomas Alexander Bean, one
of the first documented patients with
multiple myeloma (MM), underwent
a battery of treatments – blood-letting,
cupping, and even leeches for “mainte-
nance therapy.” Amazingly, he lived for a
few more years before succumbing to his
disease in 1846. 1
If he had been diagnosed today and was
ineligible for hematopoietic cell transplan-
tation (HCT), Mr. Bean would have had a
host of promising MM therapies available
to him and likely would have survived years
longer.
The field of MM has seen a recent ex-
pansion in treatment options: In November
2015, the U.S. Food and Drug Adminis-
tration (FDA) approved the monoclonal
antibodies daratumumab and elotuzumab
and the proteasome inhibitor ixazomib
for patients with previously treated MM.
Earlier that year, panobinostat became the
first FDA-approved histone deacetylase
inhibitor for MM treatment. (See the TABLE
for a rundown of all available agents indi-
cated for MM treatment and the potential
combinations for each.)
But this wealth of treatment options
comes with challenges, as clinicians must
determine which drugs to use, as well as
when to use them and in what order. ASH
Clinical Ne