Amrita Krishnan, MD

Adverse Event Management and Treatment Response Assessment

With the advent of the patient portal, communication between patients, families, and the care team has become much easier and more efficient. When patients experience side effects, they often send messages describing their symptoms. The care team reviews these messages, then follows up with a phone call to clarify details and identify which medication might be causing the problem. For example, a common side effect of certain treatments is a skin rash. Patients are asked to send photos via the portal, allowing the care team to assess the severity and characteristics of the rash more accurately. This helps differentiate between treatment-related rashes and other skin issues, enabling tailored advice on managing side effects while keeping patients on their essential therapies. Patients are also educated on when to use the triage line for urgent concerns, ensuring timely care.

Monitoring treatment effectiveness is a critical part of care and relies heavily on blood tests. Myeloma proteins in the bloodstream have different half-lives—some, like IgG, may remain for about a month, while others, such as kappa or lambda light chains, clear within hours. This means that testing too soon after treatment may not provide an accurate picture of response. Generally, the care team waits around four weeks before evaluating treatment effects to allow enough time for changes to show. In addition to blood tests, imaging studies such as PET scans and bone scans are used intermittently to assess bone involvement, but these are done less frequently due to cost and radiation exposure. Bone marrow biopsies are also performed but only at key points since they are invasive and uncomfortable for patients.

Advanced testing like minimal residual disease (MRD) analysis, which detects very low levels of cancer cells, requires bone marrow samples and helps guide long-term treatment decisions. Because no single test perfectly captures disease status, the care team carefully balances how often and which tests to use, aiming to monitor progress closely while minimizing patient discomfort and disruption. This thoughtful approach allows for personalized care, combining thorough disease assessment with attention to quality of life.

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Panelists discuss how patient portal use improves communication by allowing patients to report side effects with photos for accurate evaluation, and how treatment effectiveness is monitored through carefully timed blood tests, imaging, and bone marrow biopsies—including minimal residual disease testing—to balance thorough assessment with minimizing patient discomfort.

Patient Perspective: Navigating Multiple Myeloma Treatment

When first confronted with a multiple myeloma diagnosis, patients are often overwhelmed by both the emotional impact and the volume of medical information. In this case, the patients quickly went into "warrior mode," conducting extensive online research to better understand treatment options and terminology. Initially, they expected a standard three-drug regimen followed by stem cell transplant and maintenance therapy. However, after meeting with their physician, they learned about a more cutting-edge four-drug regimen that was still emerging in the field at the time. The treatment included daratumumab (an immunotherapy), lenalidomide (an immunomodulatory pill), bortezomib (a proteasome inhibitor injection), and dexamethasone (a steroid), followed by stem cell transplant and long-term maintenance.

This approach, referred to as a "package," was based on research that later formed the foundation of the landmark Perseus Trial. The patients appreciated that their physician was ahead of the curve, offering access to the most advanced therapies years before they became mainstream. Their treatment decisions factored in not only the specifics of the disease—such as risk level and genetic features—but also their family circumstances, personal goals, and the desire to maintain quality of life. This collaborative, personalized planning helped build confidence in the treatment process and contributed to a deep, durable remission lasting more than seven years.

The patients also emphasized the importance of clear communication and shared decision-making. At a time when medical terminology felt foreign and the emotional weight of an “incurable” diagnosis was heavy, they valued how their care team took the time to explain everything in writing, considered their family responsibilities, and helped restore a sense of control. Rather than being told what to do, they were invited into the decision-making process, which helped ease the anxiety and uncertainty of the early days following diagnosis.

Panelists discuss how patients newly diagnosed with multiple myeloma often face emotional and informational overload, but collaborative, personalized care—including early access to cutting-edge four-drug regimens, clear communication, and shared decision-making—can empower them, ease anxiety, and support long-term remission and quality of life.

Treatment Initiation and Supportive Care Processes

When preparing patients with multiple myeloma to begin treatment, healthcare providers focus heavily on education and support. The initial diagnosis can be overwhelming, and patients are often unfamiliar with the complexity of the four-drug regimen commonly used as first-line therapy. Providers assess each patient’s understanding of their diagnosis and gradually introduce treatment-related information. This includes thorough explanations of each medication, its purpose, method of administration, and potential side effects. To aid comprehension and reduce confusion, patients are often given a summary sheet that outlines the treatment plan and drug details, helping them track what to expect throughout the course of therapy.

Patients are also informed about the logistics of treatment, such as the need for weekly clinic visits for blood work and infusions, as well as the oral medications they’ll need to manage at home. Addressing the practical and emotional impact of this schedule is key, as patients frequently wonder how treatment will affect their daily lives. Providers emphasize the importance of getting reliable information directly from the care team rather than relying on internet searches, which can be misleading or frightening. Trusted resources and patient education tools are shared to provide clarity and reduce anxiety.

Supportive care is another critical aspect of the treatment plan. Because myeloma patients are immunocompromised, they are often prescribed preventive medications. These include antiviral drugs such as acyclovir to guard against shingles and aspirin to lower the risk of blood clots associated with immunomodulatory drugs like lenalidomide or pomalidomide. Patients are also advised to monitor for symptoms of complications and communicate regularly with their care team. In some cases, intravenous immunoglobulin is administered to boost the immune system. Altogether, these measures aim to reduce side effects, enhance safety, and help patients feel empowered during their treatment journey.

Panelists discuss how preparing multiple myeloma patients for treatment involves structured education, emotional support, and proactive symptom management—emphasizing clear communication about the four-drug regimen, logistics, and supportive care to empower patients and ensure safety throughout their treatment journey.

Treatment of Multiple Myeloma

The discussion shifted to treatment considerations for multiple myeloma, focusing on how decisions are influenced by both patient-specific and disease-specific factors. Clinicians assess the stage of the disease, chromosomal abnormalities, and whether the patient is considered high-risk or standard-risk. Additionally, the overall health of the patient—such as the presence of kidney impairment, high blood pressure, or diabetes—plays a critical role in shaping the treatment approach. These factors together help determine what intensity of treatment a patient can tolerate and which therapies are likely to be most effective.

For patients healthy enough to undergo intensive therapy, the standard of care now includes a four-drug regimen. This multi-agent treatment strategy has become widely accepted, particularly following a landmark clinical trial published in a major medical journal. The regimen typically involves four drugs used upfront, followed by an autologous stem cell transplant. After the transplant, patients receive consolidation therapy and then move into a long-term maintenance phase, often using two drugs to help sustain remission. This comprehensive, staged treatment strategy aims to deliver deep and lasting disease control.

The trial discussed—referred to as the Perseus Trial—demonstrated highly promising results. One of the most significant findings was the projected progression-free survival, which now approaches 200 months. This represents a major milestone in the treatment of multiple myeloma, signaling a substantial improvement in the ability to keep the disease in remission over the long term. The discussion framed this evolving treatment approach as a "whole package" strategy that integrates multiple stages of therapy, each contributing to more durable disease control and improved outcomes for patients.

Panelists discuss how treatment decisions in multiple myeloma are guided by disease risk, patient health, and evolving clinical data—highlighting the shift toward a comprehensive, multi-phase approach that begins with a four-drug induction regimen and stem cell transplant, as supported by the Perseus Trial’s promising long-term remission outcomes.

Amrita Krishnan, MD

Adverse Event Management and Treatment Response Assessment

Patient Perspective: Navigating Multiple Myeloma Treatment

Treatment Initiation and Supportive Care Processes

Treatment of Multiple Myeloma

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