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Continuing the search to find a cure: thoughts before ASH 2011

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Almost a decade ago now, I collaborated with Faith Reidenbach in publishing an article in CURE magazine describing the status of myeloma therapy (DEEP IN THE BONE: Managing Myeloma: CURE magazine Vol I: pp 31-38 2002: @ curetoday.com).  At that time, we were very excited about the recent availability of the novel agents, thalidomide (Thalomid®) and bortezomib (Velcade®).  Dramatic responses had occurred and patients previously without options were having new remissions lasting over 2 years (unheard of at that time).

I discussed the role of thalidomide plus dexamethasone pre-autologous transplant and the pros and cons of long term low dose thalidomide maintenance.  And so it began: the evaluation of combining novel and traditional high dose chemotherapy approaches.

So how far have we come in this last decade?  Patients are definitely living longer and better lives with many fewer complications of myeloma and side effects from treatment.  The average life expectancy has essentially doubled from 3 years to 6 years.  Patients under age 50 years with good risk features (i.e. low ISS stage; normal [or good risk] chromosomes on FISH testing) can reasonably expect to live in excess of 10 years.

 This is huge progress and pushes the search to find a cure in two directions.  Firstly, get the maximum mileage from novel combinations to further extend survival.  But, secondly look for something completely new to truly wipe out myeloma and establish a cure.

Article - CURE Magazine - Myeloma -B Durie 2002_Page_1.jpg

As we look toward ASH for 2011, we see continued refinement of new combinations.  Since it takes time to assess long term follow-up, it is hard to know for sure the added value of ever more complex regimens.  Caution about potential toxicities is an increasing concern. Full discussion of ASH highlights will be posted next week.

The need for a continued search for a cure is emphasized by the current special issue of Science magazine: 25 November 2011, Vol. 334, pages 1046-1051, *Mysteries of the cell*.  Five articles discuss what we still need to understand about how the cells of the body function.  What is the exact structure of the cell membrane?  How does a cell control its size?  How does a cell organize the positioning of all the different pieces of the cell?  How do cells know when they need to eat to get more energy and nutrients?  And, finally, do genes function differently if in a new location within the cell?  All crucial questions!  So we need to be very humble as we pose new questions about myeloma.  We have so much to learn about how both normal and cancerous cells work!  It is truly amazing and encouraging that despite that, major progress is being made every single day as research moves ever forward.  

But what about the cure?  Not much to report yet.  Dr. Ed Stadmauer reports that two trials, using re-infused T-lymphocytes from patients "armed" (with carefully selected warheads) against myeloma, are ongoing with early but promising results.  A new vaccine trial at Hadassah University Medical Center in Jerusalem has been recently announced.  The "one shot cure" approach announced by Dr. Russell at the IMWG Summit in London in the summer is proceeding with a first trial reaching the phase I patient stage and a second approach (probably the more promising of the 2) for now, just at the level of animal testing of the "oncolytic" (cancer destroying) virus.

The IMF is committed to both, track and report, on these two research directions which can lead to both longer survival and ultimately a cure.  Stay tuned!

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