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US Myeloma Flow Workshop in New York


On July 18-19, 2014, the IMF co-hosted the US Myeloma Flow Workshop at the Zuckerman Research Center at the Memorial Sloan Kettering Cancer Center in New York City. There were 24 participating medical centers from across the country plus representatives from the National Cancer Institute (NCI) and US Food and Drug Administration (FDA) in attendance. Attendees included key myeloma experts from the centers as well as technical staff responsible for the running of flow cytometry laboratories. US myeloma experts present included Drs. Vincent Rajkumar, Shaji Kumar, Ola Landgren, Ken Anderson, Saad Usmani, Suzanne Lentzsch, Jonathan Kaufman, Phillip McCarthy, and Andrzej Jakubowiak.

This educational workshop was structured to inform participants about the role of testing for minimal residual disease (MRD) and currently available testing procedures. The main focus was the new automated, highly sensitive flow cytometry method developed by the Spanish team for standardized detection of MRD in myeloma.

The establishment of a reliable MRD test is a key first step for the IMF's Black Swan Research Initiative. The Black Swan Research approach focuses on the use of the best MRD testing to track myeloma at the lowest levels as a basis for treatment decisions to achieve cure. It was therefore very exciting to have the top experts in flow cytometry in the room to assess the value of the new flow test for MRD.

During the workshop's morning session, Dr. Bruno Paiva (University of Navarra, Pamplona, Spain) summarized the importance of MRD testing in assessing treatment outcomes - much as he had done in March at the Salamanca, Spain, Flow Workshop before an audience of 70 global experts waiting to be convinced of the role of MRD testing using flow. After the Spain meeting, the flow cytometrists went home to set up the new method in labs from Germany to Australia. Would it be the same in the US?
Next, Dr. Alberto Orfao (University of Salamanca, Salamanca, Spain) presented to a hushed room. It was clear everyone wanted to hear all the details of the new flow cytometry method he and his team had worked for years to develop, a project that has received IMF support as a key element of the Black Swan Research Initiative.

Afterwards, the usual technical questions emerged and were answered in Alberto's typical calm, complete fashion. An interactive session followed to determine what barriers may exist to the adoption of the new flow method in the US.

As workshop presenter Dr. Brent Wood (University of Washington, Seattle, Washington) would later ask, "What is more important for us? To do our own thing? Or to come together and standardize in a way that is good for our patients?"

The consensus among workshop participants was "Yes, we want to standardize. But how?" Among the practical questions and concerns voiced were the following:

  • Do samples need to be processed in 24 hours?
  • When is the best time to get samples for response assessment?
  • How can we find the time to set up a new method in a very busy laboratory?
  • What about the costs? 
  • We have contracts for the old antibodies--how about the new antibodies?
  • What about the new software which standardizes the analysis and results?

The software for this cutting-edge test is a very important aspect because the cytometer uses eight colors and the results consist of clusters displayed in eight dimensions! If this sounds mind-bending, it really is.  Sophisticated software is required to accurately sort or "gate" the cells and determine which are myeloma cells and which are not! This is the fundamental question the new flow method can answer: are there any myeloma cells left or not--and ARE WE REALLY SURE?

Clearly everyone who attended the flow workshop was eager to have the means to answer to this question, and to be really sure. That left the matter of whether or not the practical laboratory implementation issues can be resolved in order to begin using the new flow method. The workshop participants asked the IMF team to help. There was immediate agreement that every effort will be made to assist labs that are anxious to start the new method, but which face challenges doing so.

After much excellent discussion, a dinner, and a morning session with further questions answered, participants left well informed and highly motivated to implement a new highly sensitive flow MRD method.

In the coming weeks and months, Dr. Bruno Paiva, Dr. Alberto Orfao, their teams, and the IMF team will be at the ready to assist. There is a strong sense of optimism that a reliable MRD test will be available very soon for US patients.

Stay tuned and updates will be posted along the way!


great doctors we need more people like this try find cure for cancer , i think we very close find cure

Ten years ago I was diagnosed with MM and Amyloidosis. After 3 treatments of VAD, I was in remission. After that, at my request, my oncologist gradually reduced the remaining drugs I was taking. The amyloidosis had affected my heart and I was already age 67 so I could not have a Stem Cell Transplant. The only treatment I continued was thalidomide for 4 years which I tolerated very well. Since then, I have had no treatment and all my numbers are stable when I get re-tested every 6 months. I feel I have been fully cured of both the MM and the amyloidosis for about 8 years. I mow the lawn, take care of the garden, trim the 100 feet of cedar hedge, open the swimming pool and maintain it every summer. Only yesterday, I applied a coating of tar on my asphalt driveway which measures 60 ft by 20 ft. It took me three hours to do. I feel like I did when I was 40 or 50.

I submit that I would like to be a candidate for the Zero Residual Measurement Flow Tests about to be performed. Notice, I wrote "Zero" and not "Minimal".

Don Elliott, aged 76, Montreal, Canada

This is a stupid question -- but I have always encouraged people to ask stupid questions so I may as well follow my own advice!

The question is: What is the relevance of MRD testing? Is it only for those patients who show no m-spike or can it be relevant also for those of us with an m-spike? The reason I am thinking it is stupid is that with an m-spike, presumably there must be myeloma cells producing the m-protein. On the other hand, as I recollect from my last bone marrow biopsy, they did not find any or many myeloma cells, not enough anyway to do an analysis on. Report from my FISH says: "Results
Insufficient plasma cells were observed.
[7 total plasma cells identified]

An insufficient number of plasma cells were observed using
the cytoplasmic immunoglobulin staining method. This result
does not exclude the presence of a plasma cell proliferative

My question is this- Is the new testing for MRD applicable to patients with non-secretory MM with no M-spike, or are tests for kappa lambda ratio better?

Can this be used for patients well beyond the MRD? Jerry's oncologist said the bone marrow biopsy is not very accurate--like "leopard spots". (Jerry's had 5 since diagnosis 7/12.)

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