In this episode of MD Newsline, Dr. Shaina A. Rozell, a hematologist-oncologist at Affiliate Oncology in Chicago, Illinois, explores the rapidly advancing field of multiple myeloma treatment. She discusses how quadruplet therapies, MRD monitoring, and novel immunotherapies like bispecific antibodies and CAR-T are transforming outcomes for patients. Dr. Rozell also examines disparities in access to care, the growing role of community practices in clinical trials, and the balance between extending survival and preserving quality of life.

Episode Highlights

1. The Rise of Quadruplet Therapy
Dr. Rozell explains how treatment has evolved from triplet to quadruplet regimens, incorporating agents such as daratumumab and isatuximab. These combinations have led to higher sustained MRD negativity and longer progression-free survival, offering some patients an alternative to stem cell transplantation.

2. Redefining the Role of Stem Cell Transplant
While autologous transplants remain a mainstay, Dr. Rozell notes that emerging immunotherapies may one day reduce their necessity. She compares the shift in multiple myeloma to the eventual phasing out of stem cell transplants in breast cancer.

3. CAR-T and Bispecific Antibodies
Access and feasibility play major roles in therapy selection. Dr. Rozell contrasts CAR-T—limited to tertiary centers—with bispecifics, which can now be administered in some community practices. Collaboration between local clinics and academic centers remains crucial for expanding access.

4. Supportive Care and Toxicity Management
Advances in bone protection, infection prevention, and supportive care bundles are improving patient quality of life. However, Dr. Rozell underscores the ongoing challenge of managing long-term toxicities like neuropathy and heart failure.

5. Genetic and Cytogenetic Factors
Cytogenetic abnormalities such as 17p deletions continue to shape prognosis and treatment choice. Dr. Rozell highlights the need for consistent genetic testing and patient education to ensure optimal therapeutic decisions.

6. Clinical Trial Diversity and Representation
Dr. Rozell advocates for greater minority participation in clinical research, emphasizing the importance of trust, communication, and representation among both patients and providers to ensure equitable advancement of care.

7. The Future of Myeloma Research
Looking ahead, Dr. Rozell anticipates MRD will become a central endpoint in clinical trials. She envisions a future with more home-based treatments, enhanced telemedicine integration, and continued innovation in supportive care and survivorship strategies.

Key Takeaway

Dr. Shaina Rozell underscores the transformation of multiple myeloma treatment through quadruplet therapies and MRD-driven care. By combining innovation, equity, and collaboration between community and academic centers, the field is moving closer to more accessible, effective, and personalized care for all patients.

Resources

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