1. UR, a 71-year-old male with newly diagnosed multiple myeloma (MM), is treated with a regimen of VRd (bortezomib, lenalidomide, and dexamethasone). He has a complete response (CR) from treatment that lasts 13 months. Unfortunately, UR is relapsing. He has B-cell maturation antigen (BCMA) expression on 100% of his MM cells. Which of the following treatments should be considered?
A. Rechallenge with VRd
B. Belantamab mafodotin
C. Clinical trial with BCMA-directed CAR-T cell therapy
D. Maintenance lenalidomide
E. Unsure
2. Which of the following statements regarding relapsed or refractory multiple myeloma (RRMM) is TRUE?
A. RRMM is cured in a majority of patients
B. RRMM will eventually occur in all patients
C. Less than 10% of patients will develop RRMM
D. Patients who develop RRMM within 6 months of front-line therapy have the best outcomes
E. Unsure
3. Which of the following statements regarding B-cell maturation antigen (BCMA) in relapsed or refractory multiple myeloma (RRMM) is TRUE?
A. BCMA is not expressed in RRMM
B. BCMA is expressed in high levels in RRMM, making it a useful target
C. BCMA is not a targetable antigen in RRMM
D. BCMA is expressed in all organs, making it difficult to target because of off-target adverse events
E. Unsure
4. Which of the following drugs is correctly matched to its mechanism of action and associated toxicity?
A. Belantamab mafodotin: CAR T-cell: corneal toxicity
B. Belantamab mafodotin: CAR T-cell: cytokine release syndrome (CRS)
C. Belantamab mafodotin: antibody-drug conjugate: corneal toxicity
D. Belantamab mafodotin: bispecific antibody construct: CRS
E. Unsure
5. Which of the following signs/symptoms is most commonly associated with cytokine release syndrome (CRS)?
A. Fever
B. Hepatic failure
C. Hypotension
D. Oxygen desaturation
E. Unsure
6. Which of the following potential treatments in relapsed/refractory multiple myeloma is associated with the highest risk of developing grade ≥3 cytokine release syndrome (CRS)?
A. Belantamab mafodotin
B. AMG 420
C. Idecabtagene vicleucel
D. Autologous stem cell transplantation
E. Unsure
7. Which of the following statements is TRUE regarding eyedrops in patients receiving belantamab mafodotin?
A. Steroid eye drops have been shown to prevent keratopathy
B. Eyedrops have no role in symptom management for patients receiving belantamab mafodotin
C. Artificial tears are useful in managing symptoms such as dry eye
D. Patients requiring eye drops should discontinue treatment with belantamab mafodotin
E. Unsure
8. JR is a 61-year-old male treated with idecabtagene vicleucel. He tolerates preconditioning chemotherapy and CAR T-cell infusion with no problems. On day 3 of his admission, he develops fever and a new low-level oxygen requirement (nasal cannula). He remains normotensive. Which of the following treatments is most appropriate for JR?
A. Transfer to the intensive care unit
B. Methylprednisolone 1 g intravenously (IV) every 6 hours
C. Siltuximab 11 mg/kg IV once
D. Tocilizumab 8 mg/kg IV once
E. Unsure
9. Which of the following counseling points should be included for AMG 420 administration?
A. It is given via intermittent infusion every day for 4 weeks of a 4-week cycle
B. It is given via continuous infusion every day for 4 weeks, followed by a 2-week drug-free interval
C. It is given via intermittent infusion every day for 2 weeks of a 4-week cycle
D. It is given via continuous infusion every day for 4 weeks of a 4-week cycle
E. Unsure
10. RJ is a 64-year-old male with relapsed multiple myeloma following 4 lines of prior therapy, including refractory disease after autologous stem cell transplantation, proteasome inhibitor, immunomodulatory agent, and daratumumab. He is enrolling in an investigational study using belantamab mafodotin 2.5 mg/kg intravenously in combination with other agents used in the relapsed and refractory setting. RJ has heard the results of the DREAMM-2 trial and inquires why the dose in this study is so low. Which of the following statements is correct?
A. Keratopathy was not seen in the 2.5 mg/kg dosing cohort
B. Survival at 1 year was shorter in the 2.5 mg/kg dosing cohort
C. The 3.4 mg/kg dose was preferred in patients who had received prior B-cell maturation antigen (BCMA)-targeted therapies
D. The 2.5 mg/kg dosing cohort had a better toxicity profile
E. Unsure
11. AK, a 63-year-old female with penta-refractory relapsed multiple myeloma, received JNJ-4528 as part of a phase 1 clinical trial. She tolerated her treatment well, only experiencing fever (grade 1 cytokine release syndrome [CRS]) following her infusion. She returned to clinic at 1 month and found out she had a very good partial response. She is disappointed that she does not have a complete response. What can you say to AK at this time regarding her outcomes?
A. In clinical trials, median time to complete response was 2 months
B. Complete response not seen by 1 month is associated with decreased survival
C. The fever she had probably delayed her response
D. No responses have been seen in patients with disease that is as refractory as hers
E. Unsure
Evaluation Questions
12. How confident are in your treatment choice for UR?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
13. How confident are in your treatment choice for JR?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
