Participants will partake in a multiple myeloma screening program. The screening involves a blood sample and the completion of a questionnaire to gauge participants' multiple myeloma knowledge.

Participants will be screened with a blood test for monoclonal protein analysis

Multiple Myeloma M-Protein Analysis

Participants will complete two questionnaires to share their attitudes toward their screening experience and completion of knowledge questions to gauge community reception and participant multiple myeloma knowledge.

Multiple Myeloma Knowledge Questionnaires

Telehealth visits will be performed using institutionally-approved, secure, web-based teleconferencing. The standard neurology visits will occur every 6 months with their established neurology clinician via telehealth. The comprehensive care will be offered via telehealth or within the patient's local community. The comprehensive care visits will be adapted for the individual participants' needs and symptoms, consistent with standard clinical care.

Intervention includes clinical care delivered via telehealth

Multiple Sclerosis Clinical Care Delivery via telehealth

Standard neurology visits will be conducted in-clinic visits every 6 months with their established neurology clinician. The comprehensive MS care visits will be conducted in-clinic. The comprehensive care visits will be adapted for the individual participants' needs and symptoms, consistent with standard clinical care.

Intervention includes clinical care delivered via standard in clinic visits

Multiple Sclerosis Clinical Care Delivery via standard in clinic visits

MS Participant Group 1 will receive the HOBSCOTCH-MS intervention consisting of 1:1 sessions delivered once per week including:

* 1 pre-HOBSCOTCH
* Session (on webcam)
* 1 educational session (on webcam)
* 6 telephone sessions
* 1 wrap-up session (webcam or telephone)

HOBSCOTCH is a home-based self-management program to treat cognitive symptoms and improve quality of life, while minimizing the barriers of access to care. The program is based on Problem Solving Therapy (PST) and teaches problem solving strategies and compensatory mechanisms to help manage cognitive dysfunction and enhance quality of life. HOBSCOTCH-MS is an adaptation of the HOBSCOTCH program specifically for people who have multiple sclerosis. It incorporates education about these conditions and cognition into the education module.

Home Based Self- management and Cognitive Training Changes lives in Multiple Sclerosis (HOBSCOTCH-MS)

MS Participant Group 2 will be on a 3-month wait list after which they will receive HOBSCOTCH-MS consisting of 1:1 sessions delivered once per week including:

* 1 pre-HOBSCOTCH
* Session (on webcam)
* 1 educational session (on webcam)
* 6 telephone sessions
* 1 wrap-up session (webcam or telephone)

Caregiver Group 1 will receive an adapted version of HOBSCOTCH-MS by attending the introductory session and session 1 of the HOBSCOTCH-MS (virtual) program with their MS participant as well as guidance and instructions on utilizing quick relaxation. Caregiver Group 1 will also attend session 8 of the program with the MS patient to focus on program wrap-up and maintenance planning.

Caregiver Group 2 will be on a 3 month wait list with their MS participant after which time they will receive an adapted version of HOBSCOTCH-MS by attending the introductory session and session 1 of the HOBSCOTCH-MS (virtual) program with their MS patient as well as guidance and instructions on utilizing quick relaxation. Caregiver Group 1 will also attend session 8 of the program with the MS patient to focus on program wrap-up and maintenance planning.

Meredith E Olenec

Sarah J. Kaden, BA

Elaine T. Kirikapoulos, MD, MPH, MSc

Patients receive poly ICLC IM once weekly in weeks when no vaccine is given. Beginning 2 weeks after starting poly ICLC, patients receive personalized neo-antigen peptide vaccine IM once every 4 weeks and nivolumab IV every 2 or 4 weeks. Treatment continues for 25 weeks in the absence of disease progression or unacceptable toxicity. Patients determined to have clinical benefit on a first course of treatment may repeat a 6-month course of treatment as described above. Patients then receive nivolumab IV every 2 or 4 weeks for up to 12 months in the absence of disease progression or unacceptable toxicity.

Additionally, patients may undergo ECHO or MUGA during screening. Patients also undergo tumor biopsy, blood sample collection, and CT and/or PET throughout the study.

Neoantigen Peptide Vaccine

Nivolumab

Poly ICLC

Echocardiography

Multigated Acquisition Scan

Biopsy

Biospecimen Collection

Computed Tomography

Positron Emission Tomography

FHCC Intake

Joshua Veatch

This is a prospective, interventional study involving 30 subjects who have been diagnosed with multiple sclerosis and being treated with Ocrelizumab for at least one year.

The cognitive and fatigue assessments administered in this study are not currently part of the standard clinical care for multiple sclerosis patients on Ocrelizumab. By prospectively assigning participants to undergo these additional assessments, this aspect of the study is considered investigational, and findings may contribute to clinical decision-making regarding the incorporation of cognitive and fatigue assessments into routine management of multiple sclerosis conditions.

Multiple Sclerosis patients who have been on Ocrelizumab will undergo cognitive and fatigue assessments

Lynn Huber, MBA

Sara Omar, MSc

Anza Memon, M.D, FAAN

Kyrstina Mariouw, PhD

Participants in this condition will receive a 4-month home-based, remotely supported aerobic and resistance exercise program based on the Guidelines for Exercise in Multiple Sclerosis (GEMS).

Remotely-coached/guided, home-based program delivered using telerehabilitation focusing on aerobic fitness and muscle strength as a mode of training.

Guidelines for Exercise in Multiple Sclerosis (GEMS)

Participants in this condition will receive a 4-month home-based, remotely supported stretching program emphasizing flexibility and range of motion as important components of fitness based on Stretching for People with MS: An Illustrated Manual from the National MS Society.

Remotely-coached/guided, home-based program delivered using telerehabilitation focusing on stretching and range of motion as the mode of training.

다발성 골수종 M-단백질 분석, 다발성 골수종 지식 설문지

원격 진료를 통한 다발성 경화증 임상 치료 제공, 표준 진료소 방문을 통한 다발성 경화증 임상 치료 제공

가정 기반 자기 관리 및 인지 훈련은 다발성 경화증 환자의 삶을 변화시킵니다(HOBSCOTCH-MS)

신항원 펩타이드 백신, 니볼루맙, 다발성 ICLC, 심초음파, 다중 게이트 획득 스캔, 생검, 생체 검체 채취, 컴퓨터 단층촬영, 양전자 방출 단층촬영

오크렐리주맙을 복용한 다발성 경화증 환자는 인지 및 피로 평가를 받게 됩니다.

다발성 경화증 운동 지침(GEMS), FLEX 스트레칭 및 토닝 프로그램