Day 1: First full day of ASH
Saturday December 1, 2018
It’s nearly 10 p.m. as I begin to write my daily blog, but I’m still wide awake & enthusiastic, having just attended the IMF’s annual Brian D. Novis Research Grant Awards reception. After listening to some wonderful patient stories, I was encouraged to see six young researchers presented with monetary awards totaling $360K to continue their research in areas that will potentially benefit multiple myeloma patients. It’s important to note that funds raised for these grants were from patients/caregivers/friends hosting various fundraising activities (e.g. golfing events, 5Ks, and more). And with over 140 grants given by the IMF in the past 20 years, 80% of those researchers are still focused on multiple myeloma research. If you’d like to read another blog about tonight’s event, check out one written by Jim Omel, MD, 21-yr myeloma pt and Central Nebraska myeloma upport group leader. He also attended and expressed such pride when one of his support attendees, Ron Hood, shared his myeloma story. And Ron reminded the room of the educational value of myeloma support groups and how Jim made such a difference, noting that he and his wife Sue still drive 150 each way once a month to participate in Jim’s support group. Did you know there are 150 multiple myeloma support groups around the country? Locate the one closest to you at the IMF website at https://www.myeloma.org/support-groups.
The day started with a 7:30am Education session led by Dr. Ken Anderson (Dana Farber) who was joined by Drs. Thierry Falcon (France) and Tanya Wildes (U. Washington, St Louis). They focused on both international and U.S. treatment of older, unfit myeloma patients. Their case study was a 73 year-old woman, with fatigue, back pain, early on-set diabetes, and could only walk 1 block. Her m-spike was 6.8, she was IgA lambda (lambda = 1000 mg/l), 50% plasma cells and had 17p deletion. Before each doctor made their treatment suggestions at different phases, they listed all the various options and treatment concerns. Multiple myeloma research docs really need to either propose trials for older adults or at least expand eligibility criteria for their participation.
In the U.S., induction of Revlimid, Velcade, and dexamethasone (a lower dose), or RVd-lite, was recommended (15 mg Rev days 1-21, 1.3 mg/m2 Vel, and 20mg dex once/wk) as well as Zometa once every 3 months. Outside the U.S. where, for example Revlimid might not be available, Velcade, Thalomid, and dexamethasone (VTd) or Velcade, melphalan, + prednisone (VMp) could be considered. The patient responded to RVd-lite in 6 mos…0 m-spike, normal free light chain. You might be surprised to learn that a transplant was considered but instead she continued RVd-lite for a total of 9 months? What about maintenance? Velcade was considered due to the del 17p but Rev maintenance was used instead due to grade 2 neuropathy and physical concerns associated with neuropathy.
After 2.5 yrs, she relapsed…m-spike .5 and additional lesions. She’s now 76 yo old…what to do at first relapse? She tried Dara-Pom-d but only got a partial remission and sustained an L4 fracture, putting an additional strain on her spousal care giver support. Lots to consider for older multiple myeloma patients. Dr. Falcon noted “Frailty is a stronger predictor of survival than ISS staging or FISH analysis.”
Later I attended a couple of very interest oral sessions. Abstract 121 looked at 3 treatment arms: A: KCd-SCT-KCd consolidation; B: KRd-SCT-KRd cons; and C: KRd (more cycles)-KRd cons. It turns out that both KRd arms, with or without the SCT, outperformed the KCd (Cytoxin) arm. MRD- in B & C were 58% and 54% respectively while A was 42%. However, longer follow-up is needed to better understand PFS and OS.
Finally abstract 124 in Europe examined double (tandem) versus single SCT for 909 patients and concluded that double SCT show a benefit of 1 yr improved overalll survivial (OS) (54% are still alive at 10 yrs) as well as superior progression-free survival (PFS) (median 47 mos vs 38 mos). So why do these European trials show tandem superiority while the most recent U.S. trial (STAMINA) shows no benefit? It may well be because we have access to better induction treatment in the U.S.
That’s it for today. Tomorrow I look forward to attending my first oral presentation at 7:30 a.m., and these presentations will run almost non-stop through 6 p.m.
Wishing you the best of health!