Power Over Your Mind

Power Over Your Mind

“You have power over your mind – not outside events.  Realize this, and you will find your strength.”—Marcus Aurelius, Meditations

As the 63rd annual meeting of the American Society of Hematology (ASH) wrapped up this week, I am looking to the future with hope and excitement. I admit my brain is a bit tired from trying to process all the technical data, but I am trying to have power over my mind!

Since I have relapsed twice in my 10 years of living with multiple myeloma, I tend to be very interested in any studies or information pertaining to my options at relapse.  This chart shows that there are many options and combinations available.

This year’s ASH had many updates on key clinical trials. Many of the trials were for heavily pre-treated patients who are running out of options.  My other teammates have summarized this information better than I could.  However, there was one presentation by Dr. Thomas Martin (UCSF Helen Diller Family Comprehensive Cancer Center – San Francisco, CA) with an update on the CARTITUDE-1 trial that got my attention. This is a study of a B cell maturation antigen (BCMA) directed CAR T-cell therapy called Ciltacabtagene autoleucel (cilta-cel) for heavily pre-treated, relapsed/refractory multiple myeloma patients.  When Dr. Martin took the stage, you could see the excitement in his face.  He was excited to present the data but more importantly, I think he was happy to be there, presenting to his colleagues who were able to attend in-person.  

At the International Myeloma Foundation (IMF) Best of ASH presentation, Dr. Brian G.M. Durie (IMF Chairman of the Board) commented that cilta-cel could have FDA approval by the first or second quarter of 2022.  

Last year’s ASH was all virtual.  I watched everyone make their presentations virtually.  And it is just not the same.  Even though we were virtual this year, you could sense the excitement from those who were there in-person during their presentations in front of colleagues. 

For those able to attend this year’s ASH in-person, it must have seemed like a family reunion.  So many doctors tweeting out pictures with friends or colleagues whom they haven’t seen in 2 years.  And all these myeloma doctors and researchers from all over the world work so hard to find ways to treat and hopefully, cure multiple myeloma one day.  I am in awe of what they do, and I am deeply grateful for their dedication.  

Finally, I was amazed by the Support Group Leaders’ participation in the International Myeloma Foundation’s (IMF) ASH team this year.  As I go back and read their blogs, I was amazed at the diversity of the topics. I urge you to take some time to read their blogs.  They are all so very interesting, and all from a slightly different point of view.  That’s what makes us a great team!  

Stay well and stay strong!

Sheri Baker, on Twitter @blondie1746 

ASH Day 3: It’s a Wrap!

ASH Day 3: It’s a Wrap!

December 13, 2021 – Today was the final day of ASH but it was still full of information, and to be honest, I’m a bit brain-fried.  The day began with the IMWG Conference series (with the replay available on the IMF website). I jotted a few quotes that I found interesting:

IMF Chairman of the Board Dr. Brian G.M. Durie noted that he expects “mass spec will be rolled out in the next year or so.” We’ll see it as a blood test called “Exent” from The Binding Site, which designed the original free light chain test. For many, the results on Exent may be used instead of minimal residual disease (MRD) testing via a bone marrow biopsy.

Dr. Thomas Martin (UCSF Helen Diller Family Comprehensive Cancer Center — San Francisco, CA) remarked: “We at UCSF are considering 4-drug therapy Griffin (dara + RVd) to be the new standard of care for transplant-eligible multiple myeloma patients, pending insurance coverage for the dara.”

Dr. Maria-Victoria Mateos (University of Salamanca — Salamanca, Spain) commented: “CELMoDs such as iberdomide will replace immunomodulatory drugs (IMiDs) Revlimid® (lenalidomide) and Pomalyst® (pomalidomide).”

Dr. Martin: “We’ve seen poor responses to the COVID-19 vaccine for patients on anti-B cell maturation antigen (anti-BCMA) and anti-CD38 treatments, but some patients have efficacy after their booster shot. Stopping CD38 treatment for a period of time doesn’t appear to improve booster benefit.”

And now for a few of my takeaways from today’s ASH (all treatments for relapsed/refractory multiple myeloma (RRMM) patients unless otherwise noted:

  • Dr. Jonathan Kaufman (Winship Cancer Institute, Emory University — Atlanta, GA) presented early results from a trial comparing venetoclax plus dara and dexamethasone (VenDd) vs Velcade®(bortezomib) plus dara-dex (VenDVd) for RRMM and found an overall response rate (ORR) improvement of 20+ points (87% vs 63%) [817] 
  • This study examined outcomes of RRMM patients (pts) following treatment of bispecific antibodies and concluded for N=57 pts that getting another T cell directed therapy significantly improves median progression free survival (PFS) (mPFS:19 vs 2 months) and OS (NR vs 12 mos) [821]
  • For clinical trials, it was proposed that PFS and QoL measures be co-primary endpoints rather than just PFS since many MM patients favor one over the other. [836]
  • Dr. Sham Mailankody (Memorial Sloan Kettering —Commack, NY) presented another CAR T study of MCARH109 that targets GPRC5D (not BCMA) and CD3, and eligible patients included those with prior BCMA therapy (inc CAR T as well as allo-SCT). N is small at 16 but 69% had ORR (inc 25% CR) with similar ORR for prior BCMA/CAR T. [827] 
  • For N=55, this bispecific called elranatamab from Pfizer achieved 69% ORR at the recommended phase 2 dosage (RP2D) [895]
  • Dr. Philippe Moreau (University Hospital — Nantes, France) presented results of teclistamab, another bispecific, from a study called MajesTEC-1. For N=165, ORR=62%, CR=29%, 9-mos PFS = 59% and MRD- is 17% (10-6). Dosage is .06 -> .3 mg/kg, using a step-up dosing to minimize side effects such as cytokine release syndrome (CRS), which were all grade 1/2. [896]
  • The DREAMM-5 study showed that combining Blenrep® (belantamab mafodotin-blmf) with a T cell Co-stimulator Agonist aICOS resulted in increasing single agent Blenrep ORR from 32% to 52% without increasing side effects. [897]
  • Another bispecifc ABBV-383 (previously called TNB-3838) targets BCMAxCD3. For N=76 at the RP2D (40mg via IV), ORR was 81% with >= VGPR of 69%, although for triple-class refractory, ORR dropped to 53%. [900]

Finally, there were a couple of interesting abstracts 665 and 666 that looked at the cost of saving stem cells for a 2nd transplant and the cost /wait times for doing blood draws (CBC and chem panel) before every Velcade infusion as part of RVd treatment. At Mayo Clinic-Florida, only 2% of patients get a 2nd transplant but the cost of harvest and cryopreservation totals $8 million for all their patients (average 4 years storage). And changing protocols to perform blood draws only once per cycle can save $1,500 and 3-4 hours wait time per draw times the number of draws previously done per cycle.

Well, that’s it for 2021 ASH, although I’ll likely created a blog with my final thoughts, as well as a multipage write-up for anyone that wants it.  This “virtual” hybrid platform worked for the most part, though I do miss connecting face-to-face with others. Perhaps that will happen at the 2022 ASH in New Orleans.

Be your own best patient advocate.

Jack Aiello, on Twitter @JackMAiello