February 24, 2006
Greetings from the Second European Congress on Hematologic Malignancies, organized by Imedex. Although the conference's official language is English, I will be reporting in Spanish. Who am I? My name is David Smith, and I am Vice President, Operations of the IMF as well as an alumnus of the Complutense University in Madrid and former professor at the Tec of Monterrey's Mexico City campus.
(First of all, I must mention that I am not a myeloma expert. I would like to apologize in advance if, due to misunderstanding or poor translation, I err in this report. These notes are my own, and have not been reviewed or approved).
The congress was held at the Princess Sofia hotel, near the university zone of Barcelona, on Pius XII Square on Diagonal Avenue. I arrived quickly via subway from the Rambla, the most famous street in the city.
After registering, I waited for the Congress introductory speeches. The Co-Directors were Drs. Bertrand Coiffier from Lyons, France and Eva Kimby from Stockholm. The first session of the conference was devoted entirely to myeloma. The moderator was Dr. Jesus San Miguel from Salamanca, Spain. The first myeloma presentation, given by Dr. Joan Bladé of Barcelona, was titled "The International Myeloma Staging Project" a project of the International Working Group of the IMF and one that is very important to Dr. Brian Durie, chairman of the IMF's Board of Directors. The second presentation was given by Dr. San Miguel, the third by Dr. Jean-Luc Harousseau from France, and the fourth by Dr. Meletios Dimopoulos from Greece.
After a short introduction given by Dr. San Miguel, Dr. Bladé began his presentation with more than 300 attendees in the room. (I think that there was a reason to place myeloma first on the agenda - to ensure physician participation).
1st presentation - Dr. Joan Bladé
With the logos of the IMF and CRAB (the biostatistics concern in Seattle headed by Mr. John Crowley) on the screen, Dr. Bladé described the prognostic factors of age and status (place of diagnosis; hospital vs. cooperative group, etc.) After mentioning the good and poor prognostic factors for the patients, using the past staging systems – starting with Durie-Salmon in 1975, he described the systems of Drs. Merlini, Cavo, Greipp, Bladé, and San Miguel, and finished with the International Staging System. This new system uses ß2 microglobulin and albumin.
The International Working Group received data from all over the world (Asia, Europe, and North America) and decided to create a staging system that was simple and used laboratory tests that are inexpensive and available in countries with fewer economic resources. Data from more than 11,000 patients was included. Dr. Bladé spoke about Stages I-III, mortality rates, and other factors. This is really a ground-breaking effort that included physicians and centers world-wide. For more information about the International Staging System, please consult the IMF web page at www.myeloma.org. Dr. Bladé closed by emphasizing the importance that all physicians implement this system.
2nd presentation - Dr. Jesús San Miguel
Biology of Multiple Myeloma: Basis for novel therapies. According to Dr. San Miguel, in order to better understand myeloma, it is necessary to understand the intrinsic pathogenesis of the myeloma cell. He mentioned the deregulation of more than 400 genes in cell transformation from a normal plasma cell to a myeloma cell (and mentioned that most of the changes occur in the stage from a normal cell to MGUS, not from MGUS to a myeloma cell, although most of the problems for patients occur in the stage from MGUS to a myeloma cell). He noted that it is interesting that these types of abnormalities of more common in solid-tumor cancers, not in other hematologic cancers. Since I am not an expert (far from it!) in cytogenetic studies, I won't go further on that topic. However, he stressed that these types of studies are accessible through clinical trials, not via one's hematologist/oncologist in the typical office setting.
Some key words from the presentation: host-tumor interactions, novel therapy targets, clinical manifestations, bone destruction, stromal and myeloma cells, osteoblast creation and bone damage, in all, I understand that once the myeloma cell attaches itself to the stromal cell, bone destruction begins, and that current research focus on the means by which we can interrupt and prevent this process.
3rd presentation - Dr. Jean-Luc Harousseau
Dr. Harousseau spoke of the French Myeloma Intergroup (IFM from its French acronym) and its recent studies as well as its antecedents. He mentioned that foremost, leaving everything else equal, one thing can explain the improved response to transplant, which is better chemotherapy treatments than those previously available. What is clear is that the standard melphalan/prednisone treatment does not generally give the outstanding results that adding a new therapy (Velcade®, Revlimid®, thalidomide) offers. This is particularly true for older patients who would not be good transplant candidates and/or another cytogenetic abnormality. For those patients who are good candidates for transplant, it is important to point out that a second transplant has benefit only if the first transplant did not achieve a complete response. There is also data that shows that a double transplant is not necessarily better than an auto followed by a mini-allo. He mentioned that chromosome q13 deletion is not necessarily important, unless accompanied by other abnormalities. Furthermore, in those situations where a first transplant did not yield a good response, data has shown that thalidomide helps to give better results and survival time.
4th presentation - Dr. Meletios Dimopoulos
Dr. Dimopoulos began with a brief overview of treatments used in relapsed/refractory myeloma. He emphasized the reasons to incorporate thalidomide as therapy for Stage II patients, but also underlined the side-effects (sometimes severe) of the medication. He also mentioned the APEX trial in the U.S. which showed better results from Velcade® paired with dexamethasone than dexamethasone alone. He also made extremely clear that for relapsed/refractory patients, since there is no cure for myeloma, medications should be used sequentially. There is no "perfect treatment" for all patients. Patients respond differently to therapies and we are slowly beginning to understand why. The toxicities of previous therapies can influence the decisions regarding future ones. Finally, he ended by stating that without clinical trials, we would not know what we do today about myeloma therapy. He presented the long list of therapies in clinical trials. (The IMF has a comprehensive list of clinical trials in the publications in the Myeloma Matrix series, available on IMF website). According to Dr. Dimopoulos, novel therapies are the standard for myeloma treatment, and physicians should be aware if the patient is a good candidate for transplant before beginning with a medication.
Well, that is all from the myeloma session. If you have questions, complaints, suggestions, or to receive more information from the IMF, please contact me at email@example.com.
My next report will be from Madrid - don't miss it!