Today was the official start of ASH with the Exhibit Hall open, Posters displayed and Education talks. However, the highlight of the day for me was being able to attend the IMF IMWG (International Myeloma Working Group) breakfast meeting co-chaired by Drs. Brian Durie (Cedars Sinai) and S. Vincent Rajkumar (Mayo). The IMWG consists of 160 MM experts from 31 countries, researching projects and collaborating with each other to move MM treatment forward. They publish many of the Guidelines that oncologists follow in treating their patients. For example, there's a publication on Maintenance that was "pre-published" in Blood earlier this year and will be out soon.
Over 100 MM experts attended the breakfast and discussed future guideline publications currently in review including: Management of MM for Non-transplant Eligible Patients; Risk Stratification; Updates to Kyphoplasty & Bone Health; and Global Myeloma Cure. And in development: New Drug and new Methods of Action; PET Scan and Imaging; and Refractory/Relapsed Guidelines.
The IMWG also has future projects on their table including: Correlating features from 6000 cases of long-term (e.g. more than 5, even 10 years) Complete Remissions. And it was suggested that they should also look at patients who do poorly. Perhaps we can better understand why 25% of MM patients live less than 3 years. This may also produce a more consistent definition of High Risk MM patients.
It was truly a pleasure to watch this group (my second time) share information and work on behalf of MM patients.
Besides the IMWG meeting, I saw one presentation today, that by Dr. Antonio Palumbo (Italy), although there were several other excellent speakers as well. Fortunately I can read text of their presentations on the flight home. Dr. Palumbo spoke to the question of whether or not novel therapies have supplanted transplants but really spoke about many other topics as well. He said "A Complete Response (CR) predicts long-term Overall Survival (OS) and continuous treatment prolongs Progression Free Survival." To which Dr. Rajkumar said "PFS is meaningless and we should only be looking at OS. Of course, PFS is better with a 3-drug regimen instead of 2 drugs but there's not necessarily a clinical OS benefit." [As background, Dr.Rajkumar generally treats his standard-risk MM patients with Rev-dx. He was also the lead researcher showing that low-dose Dex (40mg/wk) is just as effective as the 40/mg per day for 4 days on/off that I used to take.] Dr. Palumbo noted that there are 3 current major clinical trials trying to answer questions about transplants: early vs late vs not at all.
I checked out some of the posters and here are 3 examples I found interesting:
- Last year it was shown that there's a correlation between IMIDs (Revlimid, Thalomid) working better the more a myeloma protein expressed Cereblon. Today, a poster showed that for patients with del 17p, they also expressed less Cereblon...helping to explain why del 17p patients are considered high-risk;
- A Phase I study of Bendamustine-Rev-dx for 15 relapsed/refractory MM patients showed promising efficacy; and
- The PANORAMA trial of Panobinostat-Vel-dx for 55 pts relapsed and velcade-refractory showed an Overall Survival (CR+VGPR+PR) of 35% and Minimal Response/Stable Disease for another 54%.
Tonight I attended IMF Grant Awards reception where three MM patients shared their personal stories and the IMF awarded a number of $80K and $50K grants to researchers primed to make new discoveries benefitting MM patients in the future.
Definitely a nice way to end the day.