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Dec 7, 2012- ASH Day "0"

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blogicon_ASH2012_jacka.jpgToday is the day before the official start of ASH, otherwise know as Symposium Day.  I attended two of these symposium, one from 7am-11am and the other from 12:30-4:30 so it's already been a long day.

These symposiums were moderated by Drs Paul Richardson (Dana Farber) and Brian Durie (Cedar Sinai, IMF).  I was able to say "hi" and shake hands with both of them beforehand, and am so happy to have these world-renown MM experts on our side...and they're both such nice individuals.

Typically these symposia are set up with 4-5 other expert MM docs, and case studies or posed questions are asked that lead to their presentations. There's also interaction with the audience (500-750 attendees) via wireless keypads (same as used at IMF seminars) answering optional choice questions such as "how many MM patients attendees treat" (many answered >50) or which treatment would you consider such as "transplant or not for 70 yr old patient" (about 80% answered yes).

It was interesting how many of the presentations focused on subjects like risk stratification, gene expression profiling, myeloma clones, risk-adapted therapies and more...all confirming the belief that there really are "multiple" MM's.  You probably know about the ISS staging system for MM that looks at albumin and beta2 microglobulin to determine one's MM stage I, II, or III.  Dr. Johannes Drach from Vienna, Austria indicated that "Adding t(4:14) and del 17 factors to ISS staging provides additional prognostic information." I submitted a question to him about the effect of treatment on chromosome changes, and he answered that "Because this can happen, patients should have cytogenetic tests repeated at treatment relapse."

Another comment I found interesting was from Dr Haka Kaya (U of W, Spokane) who said "When my patient gets a bad rash from starting Revlimid 25mg, I've had success lowering the dosage to 10 and gradually working back up to 25 without the rash reoccurring".  Along those same lines Dr Robert Orlowski (MD Anderson, Houston) remarked "If you're using Velcade or Thalidomide and beginning to experience peripheral neuropathy symptoms, the best thing you can do is lower the dosage by 50% (or even stop all together) in order to reverse the PN."

 I was reminded that we'll hear more about Carfilzomib at ASH.  And there are 3 excellent new trials: Focus (Cfz vs Best Supportive Care), Aspire (Cfz-Rev-dx vs Rev-dx) and Endeavor (Cfz-dx vs Vel-dx).  All are accruing or finished accruing patients and should produce beneficial results in the future.

Sometime we hear about the "synergistic" combination of drugs, where 2 drugs together work better than adding them up individually.  Dr. Richardson said "These make good dance partners."

Dr. Jesus San-Miguel (Spain) when looking at PET-CT and MRI scans said "We cannot continue to just use x-rays where 30% of bone destruction needs to occur before the bone lesion can be detected." He also spoke about High Risk (>10%plasma and >30 g/L m-spike) Smoldering MM patients benefiting with early Rev-dx treatment in terms of delaying the onset of full-blown MM.

Dr. Durie showed an informative chart of MM patients from the Mayo clinic looking at 5 year Overall Survival Rates for age groups <65  and >65 yrs old:

2006-2010:   73%, 56% respectively

2001-2005:   63%, 31% respectively

indicating that novel therapies have had an even more positive impact for the elderly.

I'll end with a comment from Dr. Richardson who said "Before 2003 there had not been an FDA approval for Myeloma in 30 years. In the last decade, there have been 8 (!) but we still have far to go.

Long day but very inspiring. 

Jack

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This page contains a single entry by Jack Aiello published on December 7, 2012 5:36 PM.

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