Anti-CD38 monoclonal antibodies have led to improved response rates, progression-free and overall survival in randomized clinical trials (RCTs) of multiple myeloma (MM) patients. However, CD38 is expressed on both malignant and normal plasma cells, so anti-CD38 therapy can lead to hypogammaglobulinemia (HGG). Already present at baseline in many MM patients, HGG can increase the risk of infections. In RCTs, daratumumab containing arms have been associated with an increased risk of infections, particularly in the respiratory tract. To date, there have been no studies on interventions to reduce this risk. In this retrospective case-crossover study of patients receiving daratumumab, we compared the rates of infection while on and off intravenous immunoglobulin (IVIG) replacement therapy.

Long-term PI-based treatment is associated with improved outcomes in MM. Nonetheless, prolonged therapy with parenteral PIs (e.g. bortezomib) can be challenging in the real world, with median duration of therapy (DOT) of 4–7 months. Barriers to this long-term approach may include the burden of repeated intravenous/subcutaneous administration, difficulty travelling to/accessing treatment centers (e.g. due to environmental factors, travel restrictions, social/family situations), patient preference for treatment outside of a hospital or clinic setting, comorbidities, and toxicity. The US MM-6 study (NCT03173092) is investigating in-class transition (iCT) from parenteral bortezomib-based induction to all-oral ixazomib-based therapy (ixazomib-lenalidomide-dexamethasone; IRd) in the diverse US community population with the aim of increasing PI-based treatment duration while maintaining quality of life and improving outcomes. We report updated efficacy and safety for the first 101 patients.

The advent of novel therapies has led to tremendous progress in the treatment of multiple myeloma (MM). However, management of patients with high-risk disease who have failed approved agents and have rapidly progressive disease with cytopenias continues to be challenging. While palliative care is an option, many patients hope to qualify for a clinical trial option. Here we report results of a 28-day metronomic therapy (METRO-28) consisting of continuous administration of very low doses of classical chemotherapeutic agents. Sixteen-day cycles of metronomic therapy were previously shown to have a favorable response with acceptable toxicity profiles in MM patients.