Ist International Myeloma Working Group (IMWG)
Myeloma Training Course: Master Class
Day by Day Summary of Key Points
Day 1: Monday August 6, 2012
Reviewed the on-line resources of the IMF, including the iPAD APP (Myeloma Post) and website.
The 10 STEPS program was introduced in more detail and STEP 1--Know What You're Dealing With. Get the Correct Diagnosis--was presented as the course for Day 1.
- The basic concepts concerning MGUS and SMM were discussed. It was discovered that these are largely new topics for the Chinese M.D.s since they predominantly see and treat patients with advanced myeloma in their clinical practice.
- Detection of MGUS and SMM at the time of routine physical examination was discussed. This does not occur in China.
- The classification for Low and High Risk MGUS and SMM was presented.
- Key features are:
- presence of an M-component;
- size of the M-component
- and lgG versus IgA.
- One also considers the FREELITE results and findings on bone marrow flow if available including immunophenotype, DNA content and S phase.
- Distinction was made between the Risk of Transition from MGUS or SMM to MM and high or low Risk MM as characterized by FISH findings.
- The potential antibody activity of the M-component present in MGUS and SMM was discussed, including linkages to skin, rheumatologic, autoimmune and neurologic diseases.
- Finally, the causes of MGUS/SMM/MM were discussed starting with Michael Potter's pristane mouse model. It was noted that pristane is present in diesel exhaust and that many chemicals have been linked to the causation of MGUS/SMM/MM, including those present at the recent 9/11 event in New York City. [Note: Later in the series potential viral causes were discussed]
Day 2, August 7, 2012
Dr. Joseph Mikhael presented STEP 2--TestsYou Really Need, and STEP 3--Initial Treatment Selection: Getting the Best Treatment
- Emphasis was placed upon the need to not under- or over-use tests to diagnose, assess or monitor myeloma.
- The Role of Serum FREELITE was discussed.
- The particular role of imaging such as MRI and/or PET/CT was noted especially in the presence of negative x-ray findings and/or in the presence of non-secretory myeloma, extramedullary disease (EMD) and/or plasma cell leukemia (PCL).
- The use of FISH findings to identify "High-Risk Myeloma" versus others was discussed in detail.
- The details of how the Mayo Clinic "Myeloma Team" functions were presented, They were described by the Chinese M.D.s as "paradise" - a wonderful system with excellent infrastructure and staff support, which provides diagnosis and care, and conducts myeloma research.
- Dr. Mikhael presented results of a recent molecular project published in BLOOD which identified fluctuating and evolving patterns (sequential clonal changes) or "CLONAL TIDES."
- Dr. Mikhael then proceeded to review the options for frontline therapy for transplant and non-transplant situations.
- He discussed how risk is stratified using the mSMART system.
- The basis for various selection options was reviewed based upon current data.
- In general it was noted that a three-drug regimen is now preferred, although the pros and cons of two-drug versus three- or more than three-drug regimens (such as the four-drug "Evolution" protocol) must be evaluated.
Next week: More from the IMF Master Class