The outside-in takeaway of #ASH20.

Use your best available treatment early. According to Dr. @jmikhaelmd , the 1, 2 punch outcomes of initial and 1st relapse treatment are prognostic of outcome. 1/

#mmsm #myeloma #imfmyeloma

Careful sequencing of treatments, when available guided by a myeloma specialist, is important. But, this is not always easy due to the large number of combinations available, early treatments, and future drugs available. 2/

Try not to do something that will close the door on future treatment; be it treatment or side effect management. 3/

Everyone should get maintenance. For how long or with which drug combo is still in discussion. 4/

New CAR-T and BCMA target-based drugs are here. Here to satay and to be used earlier and earlier in the relapse cycle. 5/

Quality of life should be personalized and an important informant of treatment goal and measure of outcome. 6/

MRD negativity depth and duration is important. The earlier in the relapse cycle one is able to achieve that the better. 7/

Even Dr. @BrianDurieMD , the lead PI for SWOG 777, the study that established a three-drug combo of PI, ImId, and dex, was really intrigued with the PFS benefit that various trials were able to achieve with the use of Dara early in the treatment cycle of myeloma treatment. 8/

While the 4 drug jury is still out, we look forward to using MRD guidance to determine who benefits from a 4 vs 3 drug combo. 9/

But most importantly, a #myeloma expert, when available, SHOULD be part of the treatment team. /10