Day 2 of the International Myeloma Workshop
Presentations started at 7:45 a.m. Just imagine if you had been given the 8:15 p.m speaking slot more than 12 hours later!
The day's topics were: 1) treatment for newly diagnosed < 65yo; 2) continuum of care; 3) high-risk entities; 4) whether or not to treat patients with smoldering MM; and 5) bone management.
Here were the discussions I found most interesting:
Transplants these days are being looked at in phases of induction, harvest, SCT, consolidation and maintenance. And while "<65yo" was in the topic heading, speakers recognize that physiological age is more important than chronological, plus no co-morbidities and normal organ function (except a transplant can be done for patients with compromised kidney function).
Many docs also recommend cytoxin before harvest, with the goal of producing cleaner stem cells. If consolidation is done, it's typically short term, say two months of Rev-Vel-dex before lower-dose Rev-dex maintenance.
The role of CR (Complete Response) was also discussed, with some saying the goal is to always get a CR (and this may be even more important for high-risk patients). Dr. Bart Barlogie noted that duration of CR is more critical and noted that many high-risk patients get into a CR but relapse quickly.
As much as we appreciate vacations from treatment ("treatment holidays"), many MM experts believe that treatment should be a continuum and that 2011 goals should be to extend survival rather than symptom control. Others believe that prolonged therapy improves PFS (Progression Free Survival) but we should construct clinical trials to determine who benefits most by continuous therapy.
Dr. Ken Anderson noted that several new drugs don't necessarily work on their own but offer a synergistic approach when combined with current novel drugs, stressing again that combination therapies are the future because MM cells seem to have so many potential gateways for reproduction. In addition, patients can acquire genomic mutations as a result of a particular drug treatment, again stressing the need for combination therapies.
Trials are now in process to determine if early treatment can delay the progression from Smoldering MM to full-blown MM. It's hard to fathom the idea of being treated when you have no symptoms (this is still the standard of care), but it does appear that treating "high-risk" SMM does delay the onset of MM and one would hope provides Overall Survival benefit.
Finally, the effectiveness of bone scan techniques were reviewed. The bone survey (x-rays) is least effective because there needs to be considerable bone involvement (30%) for it to show up. CT scan is more effective and easier on the patient but causes significant more radiation exposure. MRI (even over CT-PET scan) is preferred because it's non-invasive and detects soft tissue disease resulting from bone disease as well as lesions.
Family Patient Seminar, Friday Afternoon
The sessions end here on Friday around 1 p.m., just in time for the folks from the IMF and local MM experts to conduct a Family Patient Seminar in Paris Friday afternoon. I'm looking forward to attending as well and figure at least I'll understand Dr. Brian Durie and what's on the slides of other presenters. I'm assuming everything else will be in French and it should be fabulously informative for local patients and caregivers.
Well it's 2 a.m. and I have a 6:15 a.m. wake-up call to get a good seat for the first presentation at 7:45 a.m. But then again, I did see the Eiffel Tower strobe lights twinkle at midnight, so all is ok.