The first official day of ASH activities started at 6:30 a.m. with the International Myeloma Working Group (IMWG) Breakfast Meeting. The IMWG is exactly that — a working group of myeloma experts from across the world, who come together periodically to investigate and create new guidelines for everything myeloma. They form different subgroups to review, collaborate, and make recommendations for new, up-to-date guidelines on many topics.
What a blessing it is to be in a room with this much talent and passion for myeloma! I feel very honored to have been given this opportunity to experience such collaboration and cooperation between experts for the good of myeloma patients all over the world.
Now, on to the oral presentations. Some highlights from Day 1 include:
Exciting information coming from the most recent update of the Griffin Study. This study is looking at Dara plus RVd in patients with ASCT eligible Newly Diagnosed MM and updated analysis includes subjects after 24 months maintenance treatment. It appears that the quad therapy yielded 81% MRD negative subjects vs the 44% with only the triplet VRd therapy. We know that sustained MRD Negativity is more important than one snapshot, but so far, 6-month and 12-month MRD negativity remain improved with quad therapy. Will this study further direct quad therapy as SOC in induction therapy and then dual therapy in the maintenance phase?
Also, final analysis of the BELLINI study supports a biomarker-driven approach in the current Venetoclax development program in t (11;14) RRMM. Consistent results from this study are showing improvement in PFS and OS in patients with t (11;14) or BCL2 high expression.
Liquid biopsies are gaining strength in research! Will checking circulating plasma cells in initial workups of patients and monitoring throughout disease management be the new standard, rather than serial bone marrow biopsies?
For many studies, one of the AIMS is to eliminate dexamethasone from the commonly used regimens. This is good news when it comes to quality of life for myeloma patients. In the future, we may be able to remove this drug that, while effective, causes many patients so many side effects that affect quality of life.
Bispecific antibodies are up and coming! Different targets are being researched including BCMA and GPRC5D, among others. Promising data from Phase I studies, doses are being escalated and safety profiles are being identified.
iStopMM is a screening that is an unbelievably HUGE undertaking, giving endless amounts of data and assuredly, for years to come! Symptomatic screening for MGUS hasn’t been studied before, and the study’s aim states to determine if early detection can lead to the possibility of cure. Less than 2-6% of myeloma patients are diagnosed at precursor states. So how can we find them early? This Icelandic study had around 150,000 subjects show interest, with about 75,000 screened in the study. Of this group, 3,725 patients were found to have MGUS. Then this group blindly randomized into 3 arms: Arm 1 (current standard of care), Arm 2 (current IMWG guidelines), and then Arm 3 (more intensive follow-up). Initial findings are promising, but no recommendations are to be made until further research continues. Additional study looked into MGUS and COVID-19. Of 72,000 eligible subjects, 32,000 were tested. Results show that MGUS does NOT increase risk of contracting COVID, nor does it make the effects of the virus more severe, if infected. GOOD NEWS! Ideas for future research on this study population include evidence of chronic allergies/auto immune diseases/familial linkage —an important and expansive research!
Reports given for dose expansion phase of iberdomide — a novel IMiD therapy, like Rev/Pom, but big differences exist. Iberdomide is tumoricidal, while Rev/Pom are not. Also, side effect profiles are completely different, as iberdomide appears to be more easily tolerated, with typical IMiD-related events like GI effects, rash, and fatigue not noted. This is exciting news, again, for quality of life!
Final thoughts of the day: new and upcoming promising therapies are simply not cost-efficient or accessible for most patients. How do we improve access to these new therapies that can offer so much hope? For some patients that do not have access to large academic centers with myeloma specialists actively involved in their care, will these therapies remain unreachable to them? How do we bridge the gap? Food for thought!
Also, I am grateful that so many studies have a focus of improving quality of life for patients. This should ALWAYS be the AIM. Some thoughts from an oncology nurse, who is passionate about myeloma and from our 10-month-old, 110-lb. Newfoundland puppy, Bean, who just wants to have some attention today.
Welcome to ASH 2021. This year, it’s hybrid-style! ASH is monitoring the recent discovery of the Omicron variant and is proceeding with a hybrid meeting to include both in-person and virtual options.
I’m grateful to the IMF for deciding months ago that the patients/support group leaders who will be attending #ASH21 will be participating virtually with us. While I will miss connecting with everyone and the excitement brought about by in-person meetings, patient health & safety is always top priority.
Fortunately, we will still be able to attend all oral and poster presentations virtually; we will be reporting to you through blogs and tweets. Please follow all the leaders on this page and search for these hashtags: #ASH21, #IMFASH21, #myeloma #mmsm
My husband Michael and I have had the opportunity to travel with Dr. Brian G. M. Durie and Susie Durie to Iceland in 2018 and 2019 to hear the research updates from the iStopMM team (Iceland Screens, Treats, or Prevents Multiple Myeloma). This is the first large-scale screening study aimed at preventing myeloma before it develops. The first results of the iStopMM screening study were published in May 2021.
There will be four iStopMM oral presentations and an additional two abstracts presented as posters at #ASH21. Dr. Durie outlined them in his recent blog which you can read here.
When we were at the iStopMM meetings in Iceland, Dr. Sigurdur Kristinsson and Dr. Saemundur Rognvaldsson presented an early version of the Tree below. The branches of this iStopMM Tree have certainly grown and as you can see, there are many diverse outcomes. I’ll try to incorporate one or two of these branches in each of my blogs.
Today, I will go over two branches from the Tree that Dr. Rognvaldsson shared with me:
Cancer screening – The iStopMM project is a population-based screening where blood samples are collected in a pragmatic and large-scale way. The iStopMM method of collecting samples passively for screening can become a model of cancer screening in the future, especially with the advent of new blood sample-based cancer screening methods.
Genetics – The iStopMM team is collaborating with deCODE genetics to do a deep analysis of the genetics of tumor cells and the genetics of people who have MM and its precursors. This can help us understand why genes and genetic mutations lead to the development of myeloma. Unique to iStopMM, repeated sampling and follow-up over time will allow us to watch these genetic changes happen from our germline genetical makeup (normal genetic makeup at birth) to the mutations leading to MGUS and then to the development of active myeloma. By understanding this timeline, we will be able to open new avenues in treating and preventing myeloma.
In closing, I will leave you with a calendar of IMF ASH links. Make sure to tune in next week as much as possible:
Friday, December 10
IMF ASH Satellite Symposium: “Adapting Clinical Practice to a Rapidly Changing Therapeutic Landscape in Multiple Myeloma”
“Research is to see what everybody has seen, and to think what nobody else has.”
Albert Szent-Gyorgyi
I tweeted the above quote after Dr. Ola Landgren (Sylvester Comprehensive Cancer Center at the University of Miami — Florida) had spoken to our International Myeloma Foundation (IMF) virtual support group in New Mexico.
Dr. Landgren, a myeloma expert, discussed new myeloma treatments and shared his new lines of research at the Sylvester Comprehensive Cancer Center in Miami—South Florida’s only NCI-designated Cancer Center. Listening to Dr. Landgren speak to our group reminded me of just how far myeloma researchers and clinicians have come in the development of myeloma treatments.
Thalidomide was first introduced as a myeloma treatment at the University of Arkansas by Dr. Bart Barlogie. Back then, the five-year survival for a newly diagnosed myeloma patient was 34% nationally. With the therapeutic advances today, we can look to overall survival from 1-3 years to 10-20 years. We also have a tremendous amount of excitement about the possibility of curing myeloma by treating high-risk monoclonal gammopathy of undetermined significance (MGUS) and high-risk smoldering myeloma (HRSMM).
Since my diagnosis in 2010, I have become so encouraged by the various treatment advances. Such advances include CAR T-cell therapy, novel bispecific antibody therapy, and new modalities to measure minimal residual disease (MRD) in early relapsed disease, along with improved imaging techniques.
Also, the advancement of genomics in multiple myeloma suggests that targeted treatment may become available in the future. I’m very excited to hear about all the research that will be presented at ASH 2021, and I am especially grateful to be part of this conference as an IMF support group leader.
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