日本骨髄腫学会ダイバーシティ推進委員会は，DE&I（diversity, equity & inclusion）を掲げ活動を2020年に開始した。現状の課題や学会員のニーズは明らかではなく，今回，2023年6月に全学会員560人を対象にメーリングリストよりアンケート調査を行った。137人（24.5%）から有効回答を得た。回答者内訳は男性114人（83%），年齢は50歳代が54人（39%）と最多であり，50歳以上の回答者が52%を占めていた。育児経験を有するのは110人（82%），介護経験を有するのは22人（16%）であった。性別による不利益を48人（35%）が感じており，その内容としては家事・育児・介護分担，昇進・昇格，資格取得のキャリア形成に関するものが多かった。今後期待するダイバーシティ企画として，性別を問わずキャリア支援や働き方改革に関する情報提供を求める意見が多かった。本研究結果を周知し，すべての学会員がそれぞれ活躍できる学会の実現を目指し，継続したDE&I推進活動が重要であると考えられた。

Measurement of minimal residual disease (MRD) is a recommended component of multiple myeloma (MM) management; however, its use in routine clinical practice is associated with some challenges. This observational study aimed to understand the use of MRD measurement in clinical settings in Japan. Physicians employed by hematology departments of medium-large hospitals who had treated more than 2 individuals with MM in the previous year were eligible to participate. Data were collected from physicians via an online questionnaire. In total, 85% of respondents reported that they currently utilize MRD measurement, most often to determine treatment response and for future treatment planning. The most commonly used sensitivity threshold to determine MRD was 10^–5. Overall, more than 70% of respondents indicated they would conduct MRD measurement in the future, but desired additional clinical evidence regarding the impact of MRD status on treatment response and the correlation between MRD status and prognosis.

We describe the case of a 44-year-old man who presented as extramedullary disease recurrence with plasmablastic transformation. Initially, the patient achieved a deep response with MRD negativity at a level of 10^–5 to treatment for newly diagnosed myeloma, which was classified as R-ISS stage I with no high-risk cytogenetic abnormalities. However, nine months after autologous peripheral blood stem cell transplantation, the patient experienced an aggressive relapse, and plasmablastic transformation was diagnosed based on the clinical course and pathology of biopsy samples collected from a large extramedullary mass. Treatments such as KdD (carfilzomib, dexamethasone, and daratumumab) and salvage chemotherapies for lymphoma were ineffective. Genetic studies using NGS and pathological examination suggested that a small fraction of myeloma cells harboring the BRAF V600E mutation detected at diagnosis might have contributed to the plasmablastic transformation. Plasmablastic myeloma is a rare subtype with a poor prognosis, and the pathogenesis remains largely unknown. This case highlights the need of a deeper understanding of plasmablastic myeloma to improve risk stratification, and develop novel, effective treatments.

Treatment strategies for transplant-ineligible patients with newly diagnosed multiple myeloma have shifted from doublet to triplet and then from triplet to quadruplet regimens. This shift to stronger treatments may increase the risk of adverse effects. We investigated the efficacy and safety of modified bortezomib, lenalidomide, and dexamethasone (BLD) as induction therapy, followed by daratumumab, lenalidomide, and dexamethasone (DLD) as consolidation/maintenance therapy (BLD-DLD therapy) in transplant-ineligible newly diagnosed multiple myeloma. In 2017–2022, eight patients were enrolled. After nine cycles of BLD, patients who achieved a very good partial response received additional cycles of BL consolidation and then switched to DLD consolidation; patients who did not achieve a very good partial response proceeded to DLD consolidation after BLD induction therapy. The DLD regimen was maintained until disease progression. For the median number of cycles of the DLD regimen, 75% of patients maintained minimal residual disease negativity. Toxicity included grade 4 neutropenia in three patients, grade 3 neutropenia in two patients, grade 3 lymphopenia in three patients, and grade 3 thrombocytopenia in one patient. No treatment-related febrile neutropenia or other adverse events requiring hospitalization were observed. BLD-DLD therapy may be an option for transplant-ineligible patients with newly diagnosed multiple myeloma.