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In the Final Analysis: Trends in Research and Treatment at ASH 2013

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New Orleans, LA December 10, 2013 - As I'm sitting here in the New Orleans airport, flight delays have given me a chance to summarize my thoughts following all the meetings at the 2013 American Society of Hematology annual conference. Here are highlights for me and all multiple myeloma (MM) patients, in no particular order:

    • Monoclonal Antibodies  This seems to be the next area beyond proteasome inhibitors (e.g. Velcade) and IMiDs (e.g. Revlimid) that will yield drugs for the field of targeted therapies.  Daratumumab, Elotuzumab, and SAR-650984 are already in trials, but I saw others which have showed success in the labs and mouse models that are heading to Phase I clinical trials.
    • Fit/Unfit/Frail  A way of categorizing patients using geriatric studies that will help determine a best treatment for older patients while focusing on quality of life.
    • Smoldering Multiple Myeloma  There's a belief that, like other cancers, earlier treatment means longer term success. While the standard treatment for SMM is watch-and-wait, there's a portion of SMM patients that are high risk and will likely progress to full-blown MM within a couple of years. Perhaps treatment for high risk SMM patients can significantly delay the onset of MM, thus preventing earlier organ damage.
    • Cytoxan Instead of Melphalan  Since Cytoxan is less likely to damage bone marrow and blood counts, several presenters recommended using Cytoxan as the alkylating agent in treatment rather than melphalan.
    • So Many Options The list of treatment options since last year's ASH continues to grow now that we have carfilzomib and pomalidomide. And there seem so be clinical trials for every diagnosis phase...smoldering through high-risk MM, newly diagnosed through relapsed/refractory. Trials are so important because that's how we move possible treatment forward, so perhaps you want to ask your MM doctor if there's a trial that's beneficial for you.
    • Maintenance  This is still a hot topic. Most agree that maintenance (a better name might be "continued treatment") improves progression-free survival.  But does it extend overall survival? I heard one doctor say it best--"Maintenance certainly helps some...we just don't know which ones."  I guess you could say the same for any treatment (e.g. transplant). More maintenance studies are necessary before there's full agreement on the benefit.

That's it. Next year's ASH meeting is in San Francisco. Together we can help each other.

 -- Jack Aiello

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