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Advancing Care in Relapsed/Refractory Multiple Myeloma: Expert Roundtable On Demand

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Description

This program is supported by an independent education grant from Johnson & Johnson. This education program is only available to healthcare professionals in the USA.

In this virtual roundtable, leading relapsed/refractory multiple myeloma (RRMM) experts Dr Ajay Nooka, MD, MPH, FACP and Dr Joshua Richter, MD explore the rapidly evolving therapeutic landscape of B-cell maturation antigen (BCMA)-directed bispecific antibodies (BsAbs) and combination strategies. This dynamic, 60-minute faculty-led conversation addresses real-world challenges in translating BCMA-directed BsAb and CD38 combination data into clinical practice, including outpatient or hybrid delivery models, infection risk mitigation during continuous therapy, and treatment sequencing decisions in RRMM. The discussion focuses on translating the latest clinical trial data into routine practice, overcoming operational barriers to treatment delivery, and resolving clinical hesitation surrounding novel combination regimens.

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Credits: 1.0 AMA PRA Category 1 Credits™

Type of activity: Enduring material (On-demand)

Launch date: 18 August 2026

Expiration date: 24 April 2027

Estimated time to complete this activity: 60 minutes

Session Overview

Implementing Outpatient and Hybrid Delivery of BCMA BsAbs: Faculty uses real-world practice scenarios to guide the safe implementation of outpatient or hybrid step-up dosing (SUD), focusing closely on optimal patient selection, rigorous monitoring protocols, and seamless multidisciplinary coordination.
Preventing Infection-Related Morbidity During Continuous BCMA Therapy: This segment focuses on mitigating infection risk during prolonged BCMA-directed therapy through standardized prophylaxis, regular immunoglobulin monitoring, and strategic dosing adaptations. It also features a brief patient advocate insight highlighting the real-world impact of recurrent infections and treatment interruptions on patient care.
Optimizing Treatment Sequencing and Combination Therapy in RRMM: Participants will examine the latest clinical trial data comparing the efficacy and safety of BCMA BsAb combination therapy against both monotherapy and alternative second-line regimens, while actively addressing the clinical misconceptions that often limit appropriate treatment sequencing.

Who Should Participate

This program is designed for healthcare professionals who are involved in the diagnosis, treatment, and ongoing management of patients with relapsed/refractory multiple myeloma (RRMM) and seek to confidently translate emerging bispecific antibody evidence and combination strategies into real-world clinical practice.

Community Hematologists/Oncologists
Academic Hematologists/Oncologists
Oncology Nurses and Nurse Practitioners (NPs)
Physician Assistants (PAs)
Oncology Pharmacists

Faculty

Dr Ajay K. Nooka, MD, MPH, FACP, is a Professor of Hematology and Medical Oncology at Emory University School of Medicine, where he serves as Director of the Myeloma Program and Associate Director of Clinical Research at the Winship Cancer Institute. Specializing in multiple myeloma and plasma cell disorders, his research focuses on improving risk stratification and evaluating novel therapies, including CAR T-cell therapies, bispecific antibodies, and antibody-drug conjugates. A globally recognized expert, Dr. Nooka serves on the steering committee of the Multiple Myeloma Research Consortium (MMRC) and holds editorial positions at leading journals, including Cancer and Clinical Lymphoma, Myeloma and Leukemia.

Dr Joshua Richter, MD is an Associate Professor of Medicine in the Division of Hematology and Medical Oncology at the Icahn School of Medicine at Mount Sinai and serves as the Director of Multiple Myeloma at the Blavatnik Family Chelsea Medical Center at Mount Sinai. Specializing in multiple myeloma and related plasma cell disorders, his clinical and translational research focuses on the design and implementation of clinical trials evaluating novel therapeutics, including bispecific antibodies, CAR T-cell therapies, and innovative combination regimens. A dedicated educator and prominent voice in the hematology community, Dr. Richter frequently presents his research at major international oncology conferences and is deeply committed to optimizing treatment sequencing and side-effect management to improve patient outcomes.

Continuing Education Information

Commercial support: This activity received monetary support through an independent education grant from Johnson & Johnson.

This continuing education activity will be provided by AffinityCE and MedAll. This enduring activity will provide continuing education credit for physicians. A statement of participation is available to other attendees.

Disclosures

Dr Ajay Nooka has disclosed financial relationships within the past 24 months with the following ineligible companies: Consultant / Advisor: AstraZeneca, Blue Earth Diagnostics, GlaxoSmithKline, Janssen, KITE, ONK Therapeutics, OPNA, Pfizer, Sebia, Perspective Informatics and Premier Research. These disclosures are made in accordance with ACCME standards to ensure transparency and objectivity in continuing education. Dr Nooka does not intend to discuss non-FDA uses of drug products and/or devices only in relation to products for which he has no financial relationships.

Dr Joshua Richter has disclosed financial relationships within the past 24 months with the following ineligible companies: Consultant / Advisor: Janssen, BMS, Pfizer, Karyopharm, Sanofi, Takeda, Genentech, Abbvie, Regeneron, Forus, Menarini, Kite/Arcellx, UB Therapeutics. Speakers bureau: Janssen, BMS, Sanofi, Adaptive Biotechnologies, Pfizer. These disclosures are made in accordance with ACCME standards to ensure transparency and objectivity in continuing education. Dr Richter does not intend to discuss non-FDA uses of drug products and/or devices only in relation to products for which she has no financial relationships.

AffinityCE staff, MedAll staff, as well as planners and reviewers, have no relevant financial relationships with ineligible companies to disclose.

Mitigation of Relevant Financial Relationships

AffinityCE 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 CME activity, including faculty, planners, reviewers, or others, are required to disclose all financial relationships with ineligible companies.

All relevant financial relationships for anyone involved with the content of this activity have been mitigated prior to the commencement of the program.

Activity Accreditation for Health Professions

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physician assistants should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioners

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Nurse practitioners should claim only the credit commensurate with the extent of their participation in the activity.

Nurses & Other Professionals

All other health care professionals completing this continuing education activity will be issued a statement of participation indicating the number of hours of continuing education credit. This may be used for professional education CE credit. Please consult your accrediting organization or licensing board for their acceptance of this CE activity.

System Requirements

Mobile device (e.g., large-format smart phone; laptop or tablet computer) or desktop computer with a video display of at least 1024 × 768 pixels at 24-bit color depth, capable of connecting to the Internet at broadband or faster speeds, with a current version Internet browser and popular document viewing software (e.g., Microsoft Office, PDF viewer, image viewer) installed. Support for streaming or downloadable audio-visual materials (e.g., streaming MP4, MP3 audio) in hardware and software may be required to view, review, or participate in portions of the program.

Unapproved and/or off-label use disclosure

AffinityCE/MedAll requires CE faculty to disclose to the participants:

When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and
Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.

CME Inquiries

For all CME policy-related inquiries, please contact us at ce@affinityced.com.

Participation Costs

There is no cost to participate in this program.

To Earn CME Credit:

1. Review the program materials

2. Click the green button on the right to "Claim CME credit"

3. Complete the Post-Test; this test features real-time learning. You will receive immediate feedback and rationales explaining the correct answers as you go. The requirement is 70% accuracy.

4. Once you have successfully passed the test and completed the required CME evaluation, your certificate will be available for download and emailed to you.

Disclaimer

This activity is intended for educational purposes only and does not establish a standard of care or replace clinical judgment. Any therapeutic or diagnostic strategies discussed must be evaluated in the context of each patient’s clinical circumstances, risks, and current evidence.

Learners should consult authoritative clinical guidelines and approved product information when considering treatment decisions.

All materials are used with permission. The views expressed are those of the faculty and do not necessarily reflect those of the accredited providers, MedAll, or any supporters.

Content is accurate as of the date of release.

Learning objectives

Implement outpatient or hybrid SUD pathways for BCMA-directed BsAbs in appropriate RRMM patients.
Integrate proactive infection-mitigation strategies into the longitudinal management of RRMM patients receiving continuous BCMA-directed therapy.
Analyze the latest clinical trial evidence to appropriately utilize combination regimens for RRMM that include anti-CD38 antibody treatment alongside BCMA-directed BsAbs when clinically appropriate (including comparing the data to monotherapy and to other second line therapies).

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Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello and welcome to today's CME accredited roundtable on evolving strategies in the treatment of relapse and refractory multiple myeloma. My name is Doctor Joshua Richter. I'm an associate professor of medicine at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, and the director of myeloma at the Blavatnik Family Chelsea Medical Center at Mount Sinai. Uh, but before we begin, we will display our faculty disclosures on the screen in accordance with accreditation requirements. The therapeutic landscape for relapse and refractory multiple myeloma is rapidly evolving, yet integration of novel strategies into real world practice remains inconsistent as BCMA directed by specific antibodies redefine treatment options. Many health care providers face challenges translating clinical trial evidence into safe and effective and timely care delivery. I'm really delighted to be joined today by my absolutely outstanding colleague Doctor AJ Nka. Sir, I'll pass it to you to introduce yourself. Thank you, Doctor Richter. Always a pleasure to be with you. My name is Ajaynukka. I'm the director of the Myeloma Program at Emory Windship Cancer Institute. I'm the associate director for clinical research at the Windship Cancer Institute. Thank you so much for joining us today. In this discussion we're gonna be focusing on three key areas. One is protocols for outpatient or hybrid step up dosing for BCMA bi-specific antibodies, proactive prophylaxis and infection risk management, and treatment sequencing using the latest data for BCMA bi-specific and CD38 combination therapies. Let's begin. So Doctor Richter, so we've seen a lot of these biospecific antibodies that were approved. So, the biggest challenge that comes in here is the step of dosing with each of these. So, the question to you is, how do you implement these outpatient and hybrid delivery of the BCMM bio-specific antibodies? And could you briefly start by discussing the patient eligibility for outpatient PCMA bi-specific antibody therapies? Absolutely. So I think this is a really hot topic, and, you know, in, in my mind, this is a little bit like, you know, the Goldilocks porridge, you know, you know, too cold, just right or hot, and, you know, this is really trying to identify the individual patient. Uh, so, as you said, we type of risk stratify our patients. Um, what type of caregiver do you have, what type of comorbidities do you have, and what is the status of your disease. If you are older, frailer, or have very aggressive disease where we may worry about acute toxicities even though. Higher grade ones like CRS and Icons, we may admit you. However, patients who are fitter or have lower burden disease and or good caregiver support, we can either administer in a hybrid model where some of it is done inpatient, some outpatient, or even entirely outpatient. And really one of the key pain points to me that's worthwhile to discuss when implementing this is who gets that first phone call. And in many of us in academic centers, that may be a fellow, and our fellows are wonderful, but some of those fellows are brand new. So making sure that. Whomever gets that first phone call, whether or not it's the on-call attending, a fellow or a hospitalist, they know how to direct patients and what the schema is for patients that may need transitioning from the outpatient setting to the inpatient setting or need a higher level of care. It's an extremely helpful overview of how we're approaching this early decision of who to treat as an outpatient and who to treat as an inpatient. Now, let's see what our audience thinks about patient eligibility for outpatient BCMFI-specific antibody therapy. So, question number 1, which of the following would you not consider to be an eligibility criterion for outpatient BCMA biospecific antibody therapy? Again, the question is, which of the following would you not consider? So, option number A, no underlying cognitive issues. Option B, reliability and contractability. Option C, caregiver support. Option D, ability to use portable monitoring devices. Option A, no history of alcohol abuse. The correct answer here is no history of alcohol abuse. So back to you, Josh. We talked about implementing outpatient BCMMI-specific therapy from a patient and a clinical perspective. But when it comes to the individual therapies, what are the implications of CRS's timing and the label-based monitoring for practical outpatient management? So this is a really important thing to get granular because at the time of this recording we have 3 FDA approved BCMA by specific antibodies tlistumab, L-ranatimab, and linvaseltamab, and it's important to note that tlistumab and L ranatimab were administered as subcutaneous infusions, whereas linvaseltamumab is administered as an intravenous, uh, administration. And because of the intravenous administration, the time to onset of CRS is significantly shorter, around 10 to 12 hours, as opposed to 1 to 2 days for the sub Q-based therapies. So this is really important to take into mind in terms of after the drug is done being administered, do you want to admit the patient for 24 hours or keep them in the infusion center for outpatient monitoring in our current practice we adminis uh we admit our patients, uh, overnight after the first IV dose of Livaseltamab, uh, for monitoring, uh, and if they're stable in the morning, send them home, uh, and continue the rest of this as an outpatient. Uh, for those patients getting the subcutaneous formulations like taclizumab or L ranatimab, we offer the same, but depending upon their, uh, level of fitness in terms of how much we think they can tolerate the safety of outpatient management, we either admit them or discuss complete outpatient administration. That's wonderful. I'm glad that you're doing it, uh, based on the timing of the CRS for lenvaultumab, you're saying that median time to CRS is 1111 hours. So given that probably it's a, it's an IV infusion, and you're expecting the CMAX to be much higher, and that's what I believe the CRS is happening sooner. So, you, and you're able to discharge those patients very early on. So, in, in the setting of all these agents causing. Incidence of CRS, not too much of a high-grade toxicities, but can you briefly explain what the role of toluzab in the prevention and management of CRS, Josh? Absolutely. So I think in the early days of bispecifics when patients were developing CRS at relatively high rates in some of the early trials, 50 to up to 80% of patients, our primary treatment modality would be tocilizumab, the anti-IL-6 monoclonal antibody. But over time we've seen both in the CART world and the bi-specific world, uh, the incorporation of using prophylactic tocillizumab to prevent the onset of CRS and if you get it to lower the grade, hopefully. And as of January of 2025, the NCCN guidelines now include a reference to the use of prophylactic toillizumab to reduce the incidence of CRS. And in our practice, we actually give everyone prophylactic tosillizumab, and when we looked at our recent data, we now have fewer than 10% of our patients having any type of CRS event. The majority of these are grade 1, and because we send patients home with what we call pocket decks, uh, if they develop low grade CRS and they call us, we can administer dexamethasone as a secondary treatment modality immediately. That's very important to see that the reduction in the risk of the CRS is significantly below 10%. That is what our practice is as well, so we use prophylactic dosing regularly. Thanks, that's a great discussion around managing the CRS. I'm curious how this translates into real-world practice. So let's ask our audience. So, do your patients who receive outpatient BCMA treatment receive doluza prophylaxis? The Options are routinely, selectively, rarely, or never. Back to you, Josh. Can you take us through a workflow for managing AE symptoms following the administration of a BCMA bi-specific antibody in the outpatient setting? Absolutely. So, uh, when we administer, uh, the bi-specific, uh, obviously we're giving prophylactic toillizumab, and we'll have at least some degree of monitoring once the injection or the infusion has completed just to make sure the patient doesn't have any acute toxicities. And again because linnvaseltumab does have an IV administration. It also carries with it a low rate of infusion related reactions which we monitor for. Any infusion related reactions are dealt with immediately by the infusion nurse, uh, with supportive medications that are included in the beacon order set to provide immediate relief from any of these acute toxicities. Uh, once the patient is ready to be discharged home, we make sure that the lines of communication and the follow-up plan is well laid out. The patient and caregiver are given a card with a contact number to make sure they know who to call.