Tuesday was Day 1--Opening Day for the International Myeloma Workshop. Presentations began at 10 am and ended at 7:30 pm (the next 2 days begin at 7:45 am, so this was a "short" day).
Did I tell you that these meetings are being held at the Louvre? There are 2,000 MM researchers and oncologists from 67 countries just a stone's throw from Mona Lisa.
Today's presentations focused on myeloma genetics and cell biology, topics that are typically over my head, and I know won't affect decisions we need to make today or this year. That said, I'm glad these topics are being investigated, and I usually end up with a few takeaways.
We're always told that myeloma is a very complex disease and that treatments work differently for each of us because seemingly no two MM's and no two people are alike. Today's presentation only reaffirmed that. Researchers know that MM needs to be further stratified and classified so that ultimately we know which treatment is best for us. It may also make a difference in establishing targeted clinical trials.
At the moment, we know some differences among our fellow patients. Examples include our stage--anything from MGUS to Smoldering, to Stages 1, 2, and 3. We probably know some folks are IgG or IgA, kappa or lambda, some know they are "standard risk," some are "high risk."
That's where some of the difficulties begin. Some researchers define "high risk" as factors determined by FISH and cytogenetic tests, such as non-hyperdiploidy, chromosome deletions and translocations. However, that seems very broad. Other classifications include Gene Expression Profiling, SNP arrays and next-generation genomics sequencing techniques.
I think one of the presenters summarized it best when he said, in so many words, that "classifications today of MM appear to involve overlapping subsets rather than distinct buckets."
Bone disease was also discussed today. For bisphosphonates, 50% of Aredia or Zometa ends up in the bone but 50% gets flushed through the kidneys. However, these have both been shown to reduce skeletal events by 50%, and recently Zometa showed an anti-myeloma benefits of several months (probably true for Aredia as well). ONJ (osteonecrosis of the jaw) affects 3.5% of patients--something we need to be aware of--but I still would (and did) take bisphosphonates when recommended.
There are also studies indicating proteasome inhibitors like Velcade and IMIDS such as Revlimid may also help reduce bone loss. However, when it was asked if patients therefore don't need bisphosphonates, the MM experts agreed that patients diagnosed with bone involvement should still start bisphosphonates early in their treatment.
Finally, in a prior blog I mentioned the IMF's International Myeloma Working Group (IMWG). Near the end of tonight's meeting, Susie Novis, IMF President, showed a 5-minute video about the IMWG. It's a great video and if it isn't posted yet on the IMF website, it may very well be there by the time you reach this, just as there are already a couple of videos already posted from IMW.Gotta get some sleep now since it's a long day and early start to Day 2.