This document summarizes the outcomes of a continuing medical education (CME) activity on strategies to maximize response rates and outcomes in multiple myeloma. Key findings include: - Participant knowledge improved from pre- to post-activity based on multiple choice question responses. Participants also reported that the activity improved their knowledge and attitudes. - Participants were highly satisfied with the activity and felt it helped them achieve the learning objectives. - Participants reported they would make changes to their practice as a result, including increased use of new agents and maintenance therapies. - Participants' confidence in managing multiple myeloma increased from pre- to post-activity across several key learning objectives. This has the potential to positively impact care for their

1. Strategies to Maximize Response Rates and Outcomes in
Multiple Myeloma
52nd American Society of Hematology Annual Meeting (ASH) CME Satellite
Symposium Held Friday, December 3, 2010 in Orlando, Florida
A Jointly Sponsored Educational Activity by The Multiple Myeloma Research Foundation, Penn
State College of Medicine, and Curatio CME Institute
Post-Meeting Metrics Report
March 3, 2011
©2011 Curatio CME Institute Page 1 of 9

2. OUTCOMES SUMMARY
• Participation (Level 1)
o 45 participants completed the evaluation (33 physicians and 12 non-physicians).
o 50 participants completed the presurvey (32 physicians and 18 non-physicians) and 22
participants completed the postsurvey (14 physicians and 8 non-physicians) resulting in
19 sets of matched pre- and postsurveys (15 physicians and 4 non-physicians).
• Satisfaction (Level 2) was very high with participants; write-in responses noted that “the
speakers were clear/excellent”
• Knowledge (Level 3) was improved pre to post activity
• Change in competence (Level 4) was positive based on commitments to change listed by
participants. The topics reflecting the most practice changes listed by participants to be
implemented as a result of participation in the activity include:
o Increased use of RVD in newly diagnosed patients
o Use of lenalidomide as post-ASCT maintenance therapy
• Change in performance (Level 5; surrogate measure) was improved pre to post activity as
evidenced by 30% to 41% of participants increasing their level of confidence in their ability to
meet the outlined learning objectives
Demographic Information
Approximate
Number of number of patients
years in per week you
Profession Type of practice practice manage with MM:
• 88% Physician • 56% Community/private • 24% 0–5 • 11% 0
• 0% Resident/fellow • 0% HMO • 6% 6–10 • 29% 0–5
• 0% Physician • 25% Academic • 24% 11–15 • 24% 6–10
assistant • 6% Hospital • 18% 16–20 • 18% 11–15
• 6% Nurse • 13% Other • 28% >20 • 6% 16–20
• 0% Nurse o Pharma • 12% >20
practitioner o Industry
• 6% Other (PharmD)
EDUCATIONAL IMPACT SUMMARY
Using Moore’s 2009 Levels of Outcomes-Based CME Evaluation Model* as a guide, Curatio has developed
outcomes tools to measure the degree to which our activities achieved their intended level of outcome. Each
activity is directly measured for the following criteria: participant’s change in knowledge (Level 3; objective
and subjective data), change in competence (Level 4; subjective data), change in practice performance
(Level 5; subjective data), and change in health status of patients due to changes in practice (Level 6;
subjective data).
3–6-Month
Presurvey/
Evaluation Postactivity
Postsurvey
Assessment
Outcomes Tool
Outcome Level 3–5 3–4 3–6
*Moore DE, Green JS, Gallis HA. Achieving Desired Results and Improved Outcomes: Integrating Planning and
Assessment Throughout Learning Activities. J Contin Educ Health Prof. 2009;29(1):1-15.
©2011 Curatio CME Institute Page 2 of 9

3. We were able to show that the participants of this activity were able to improve their professional practice
with respect to knowledge, competence, and performance (see Table 1).
Table 1. Overview of Educational Impact
Participant Participant Participant
Knowledge Competence Performance
Improvements
Strength of Evidence Objective Subjective Subjective
Level 1: Participation
Physicians Non-physicians
Participants who claimed credit 33 12
Level 2: Participant Satisfaction
To assess the degree to which participants were satisfied with their experience with this activity we
evaluated the following areas:
• Faculty
• Learning objectives
• Fair balance and commercial bias
As shown in Table 2, participant satisfaction with this activity was very high.
Table 2. Participant Satisfaction
Mean Score
(5=Excellent; 1=Poor)
Ability to convey the Content was fair,
Content of subject matter balanced, and free
presentation clearly of commercial bias
Frontline Treatment in
Myeloma Patients Not 4.62 4.57 4.76
Eligible for Stem Cell
Transplantation
Induction Therapy Prior to
4.74 4.79 4.76
Stem Cell Transplantation in
Multiple Myeloma
Stem Cell Transplantation for
4.68 4.76 4.76
Myeloma: What Have the
Phase 3 Trials Taught Us?
Management of Relapsed or 4.74 4.74 4.79
Refractory Multiple Myeloma
Management of Multiple
4.67 4.56 4.74
Myeloma–Related Bone
Disease
Mean Score
This activity helped me to achieve the following (5=Strongly agree; 1=Strongly
objectives disagree)
©2011 Curatio CME Institute Page 3 of 9

4. • Interpret the latest clinical trial data and incorporate current
treatment advances to achieve best possible care of 4.51
patients with multiple myeloma
• Utilize cytogenetics, fluorescence in situ hybridization
(FISH), and gene expression profiling to define patient 4.20
prognosis and risk stratification
• Outline a treatment plan to achieve durable complete
response and extend survival in high-risk and standard-risk 4.62
myeloma patients
• Implement evidence-based strategies to prolong the
4.76
duration of response in patients with multiple myeloma
Mean Score
(5=Strongly agree; 1=Strongly
Rate the extent to which you agree or disagree disagree)
I am satisfied with the overall quality of this activity. 4.69
The activity presented scientifically rigorous, unbiased, and
4.77
balanced information
Level 3: Change in Learning/Knowledge
To assess a change in participant learning and knowledge we used the following tools:
• Multiple choice questions asked in the pre- and postsurvey (objective data)
• Evaluation of whether participation affected knowledge/attitudes (subjective data)
As shown in Table 3, this activity resulted in a positive change in learner knowledge.
Table 3. Change in Learning/Knowledge
Pre Post Difference
n=19
matched data
Post minus Pre
(% answered
Multiple Choice Questions correctly)
Which of the following post-autologous stem cell transplantation
(ASCT) maintenance therapies is associated with increases in
70% 87% +17%
complete response (CR) rate and progression-free survival (PFS)?
THALIDOMIDE, LENALIDOMIDE
Which of the following agents has been shown to exhibit an anti-
myeloma effect contributing to improvement in overall survival
59% 94% +35%
independent of skeletal-related event prevention? ZOLEDRONIC
ACID
Prior to (ASCT), the achievement of very good partial response
(VGPR) or CR is considered a strong predictor of positive outcome. 88% 94% +6%
TRUE
Primary therapy with novel agents such as MPT, MPV, Ld, in patients
who are not eligible for ASCT yields response rates and PFS that are 71% 76% +5%
comparable to those achieved with ASCT in younger patients. TRUE
Which salvage treatment(s) would you consider for a multiple
myeloma patient who had relapsed from frontline therapy and had
81% 100% +19%
experienced peripheral neuropathy? LENALIDOMIDE +
DEXAMETHASONE & THALIDOMIDE + DEXAMETHASONE
Mean Score
Rate the extent to which you agree or disagree (5=Strongly agree;
©2011 Curatio CME Institute Page 4 of 9

5. 1=Strongly disagree)
Participation in this activity changed my knowledge/attitudes 4.33
Level 4: Change in Competence
Change in Competence
To assess a change in participant competence we used the following tools:
• Evaluation of whether information provided will change clinical practice (subjective data)
• On the postsurvey, asked participants to make a commitment to change and list changes they will
make post activity (subjective data)
• Also on the postsurvey, asked participants to identify any barriers that might prevent them from
making changes in their practice
As shown in Table 4, this activity resulted in a positive change in participant competence; 8 participants
committed to make at least one specific change in their practice.
Table 4. Change in Competence
Mean Score
(5=Strongly agree; 1=Strongly
Rate the extent to which you agree or disagree disagree)
I will make a change in my practice as a result of participation in
4.14
this activity
Please identify three (3) changes you will implement in your Are there any barriers or problems
practice as a result of this activity (based on 8 respondents) that might prevent you from
implementing changes in your
practice?
• Increase use of RVD in myeloma pts (2) • Difficulty obtaining lenalidomide
• Start using RVD as induction regimen for lower socioeconomic class of
• Use lenalidomide as post-ASCT maintenance therapy (2) pts
• Maintenance with lenalidomide • Mediocre research funding
• Assess pts risk factors and treatment • Lenalidomide drug program
• Consider use of bendamustine in refract/relapsed pts usually involves a lot of paperwork
• Development of immunotherapy for myeloma • Time constraints
• Discontinue zoledronic acid @ 2 years
• Evaluate SCT therapy
• Improve outcome allogeneic transplant therapy
• Pursue new therapies
• RD for pts with neuropathy
• Refer pts for clinical trials
• Referral to ASCT even if no RR
• Treat with bone protecting agents
• Watching the progress on new (novel) agents
Level 5: Change in Practice Performance
To assess a change in participant performance we used the following tools:
• Perceived importance and self-efficacy questions asked in the pre- and postsurvey (subjective
data)
As shown in Table 5, participants considered the key educational objectives of this activity to be of great
importance, but confidence in their own ability to achieve those objectives was at a lower level. Immediately
after completing this activity, participants had greater confidence in their abilities. See Appendix for the
potential impact of positive changes in physician performance on patients.
©2011 Curatio CME Institute Page 5 of 9

6. Table 5. Perceived Importance and Self-Efficacy Questions
Mean Score
5=Very Important/Very Confident;
1=Not Important/Not confident
Pre Pre Post Confidence
How important is it to be able Importance Confidence Confidence Difference
to:/How confident are you in your n=17
Post minus Pre
ability to: matched data
Interpret the latest clinical trial data and
incorporate current treatment advances
4.63 4.19 4.44 +0.25
to achieve best possible care of
patients with multiple myeloma
Utilize cytogenetics, fluorescence in situ
hybridization (FISH), and gene
4.56 4.00 4.38 +0.38
expression profiling to define patient
prognosis and risk stratification
Outline a treatment plan to achieve
durable complete response and extend
4.63 4.19 4.50 +0.31
survival in high-risk and standard-risk
myeloma patients
Implement evidence-based strategies to
prolong the duration of response in 4.75 4.25 4.50 +0.25
patients with multiple myeloma
Level 6: Impact on Patient Health Status
To assess the impact on patient health status due to practice behavior changes, we will evaluate via our
scheduled follow-up survey (subjective data) whether the identified changes in practice implemented by
participants has affected the health status of their patients.
©2011 Curatio CME Institute Page 6 of 9

7. APPENDIX
Based on the data collected from our pre/post survey, we were able to quantify the potential impact of
positive changes in physician performance on patients based on the self-reported numbers of patients that
each learner revealed was under their care.
Pre/Post Change in Confidence in ability to interpret the latest clinical
trial data and incorporate current treatment advances to achieve best
possible care of patients with multiple myeloma (n=17)
80%
70%
60%
53% These 6 respondents hav e increased their
% of respondents
50% confidence. They see a combined total of 35
to 56 pts w ith MM a w eek (self-reported).
40%
30% 24%
20%
12%
10% 6% 6%
0% 0% 0% 0%
0%
-4 -3 -2 -1 0 +1 +2 +3 +4
36% of respondents increased their level of confidence rating (n=6)
53% of respondents did not change their confidence rating (n=9)
12% of respondents decreased their level of confidence (n=2)
©2011 Curatio CME Institute Page 7 of 9

8. Pre/Post Change in Confidence in ability to utilize cytogenetics,
fluorescence in situ hybridization (FISH), and gene expression profiling
to define patient prognosis and risk stratification (n=17)
80%
70%
59% These 7 respondents hav e increased their
60%
confidence. They see a combined total of 30
% of respondents
50% to 51 pts w ith MM a w eek (self-reported).
40% 35%
30%
20%
10% 6%
0% 0% 0% 0% 0% 0%
0%
-4 -3 -2 -1 0 +1 +2 +3 +4
41% of respondents increased their level of confidence rating (n=7)
59% of respondents did not change their confidence rating (n=10)
0% of respondents decreased their level of confidence (n=0)
Pre/Post Change in Confidence in ability to outline a treatment plan to
achieve durable complete response and extend survival in high-risk
and standard-risk myeloma patients (n=17)
80%
70%
These 7 respondents hav e increased their
60% confidence. They see a combined total of 20
53%
% of respondents
to 40 pts w ith MM a w eek (self-reported).
50%
40% 35%
30%
20%
10% 6% 6%
0% 0% 0% 0% 0%
0%
-4 -3 -2 -1 0 +1 +2 +3 +4
41% of respondents increased their level of confidence rating (n=7)
53% of respondents did not change their confidence rating (n=9)
6% of respondents decreased their level of confidence (n=1)
©2011 Curatio CME Institute Page 8 of 9

9. Pre/Post Change in Confidence in ability to implement evidence-based
strategies to prolong the duration of response in patients with multiple
myeloma (n=17)
80%
70% 65%
60%
% of respondents
50% These 5 respondents hav e increased their
confidence. They see a combined total of 19
40% to 35 pts w ith MM a w eek (self-reported).
30%
18%
20%
10% 6% 6% 6%
0% 0% 0% 0%
0%
-4 -3 -2 -1 0 +1 +2 +3 +4
30% of respondents increased their level of confidence rating (n=5)
65% of respondents did not change their confidence rating (n=11)
6% of respondents decreased their level of confidence (n=1)
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