Day 0: Symposium Day

December 6th is actually the day before ASH officially begins, often called “Symposium” day.

Today I attended the GMAN meeting and IMF Symposium. GMAN (Global Myeloma Action Network) was established about 6 years ago recognizing that Myeloma is a global disease but different countries face different issues (awareness, education, drug access, expertise) supporting myeloma patients. Our large meeting is during the summer, but this year we had representatives from 4 countries and the U.S. in addition to Pharma reps. We shared experiences in best practices in patient registries, clinical trial development, and a new GMAN website under construction. I learned that both the Czech Republic and Australia each have over 10,000 MM and MGUS patients in their registries, and the Czechs have over 900 patients diagnosed annually. The U.S. and many other countries need to develop registries so that Real World Data can be determined by following patient progress.

GMAN is developing a pilot a Clinical Trial program to launch in Feb 2020 with 5 GMAN members to help hospitals get up and running trials. There’s already a GCP (Good Clinical Practices) program to help with this.  We need to understand why, for example Norway has many trials and Finland doesn’t. And, of course, this involves many players including doctors, patient, industry, and the country’s health system.   

I then attended the IMF Symposium “Approaches to Achieve the Best Possible Outcomes in Myeloma.” I estimate about 1000 people attended and watched Dr. Brian G.M. Durie moderate a panel of myeloma experts. Based on an audience poll, 40% of attendees were from Europe and 30% see more than 20 MM patients/month. Panelists shown below are Drs. Tom Martin, S. Vincent Rajkumar, Brian G.M. Durie (moderator), Philippe Moreau, and Shaji Kumar.

All slides can be found at myeloma.org/IMF-ASH-Orlando, which provides the detailed case studies and presentations. The format is quite interesting:

1. A patient case is presented.
2. Multiple-choice questions are presented about treatment options for each topic (see below)
3. The audience votes on their answers, and the results are displayed.
4. Next, a presenter describes the best treatment practices and reasons for these practices.
5. All presenters vote on the multiple-choice question.
6. Finally, the audience votes again. (Have minds been changed?)

The doctors provided their insights on these case presentations (speaker noted). And below for each Case, I’ve listed the top 1-2 selections before/after the talk.

• Case Discussion 1: Risk Stratification of Smoldering MM…to treat of not? (Rajkumar)

Preferred treatment for HR SMM: Before-Observe: 36%; After-RVd 26%.  Note that each panelist selected “Unsure” as their choice.

• Case Discussion 2: Upfront Therapy for Newly Diagnosed Transplant-Ineligible MM (Kumar)

Treatment Options: Before: RVd:-33%; DaraRd-22%

      After: RVd-51%; DaraRd-31%

• Case Discussion 3: Upfront Therapy for Newly Diagnosed Transplant-Eligible MM (Moreau)

Treatment Options: RVd 4-6 cycles, SCT, Maintenance Rd: Before 52%; After 49%

• Case Discussion 4: Treatments for Relapsed/Refractory MM: Current (Rajkumar) and Emerging (Martin)

Current Treatment Options: Before: Observe-23% (!); Dara-Pom-d-21%

        After: Dara-Pom-d-48%; Observe-7%

Emerging Treatment Options for Progression: Before: BCMA trial-29%; Radiation-22%

After: BCMA trial-60%; Radiation-11%

See Dr Martin’s slides which provide an excellent description and trial results of future therapies. 

Interesting comments included:

For HR SMM: “Should the doctor decide for patients or should patients decide after being provided appropriate information?” —Dr. Jesus San Miguel

For SMM pts: “If the M-spike increases by 1/2 gram and hemoglobin decrease by 1/2 gram, that SMM patient has a 90% risk to MM progression within 2 years.” — Dr. S. Vincent Rajkumar

For newly diagnosed MM patients: “The older the patient at diagnosis, the lower the percentage of having high risk cytogenetics.” —Dr. Thomas Martin

For relapsed/refractory MM patients: Dr. Rajkumar suggested using the acronym TRAP: T-Timing of relapse; R-Response to prior treatments; A-Aggressiveness of relapse; P-Performance status (e.g. what can the patient handle).

CAR-T therapy: “Improvements can be made to CAR-T by 1) having multiple targets; 2) providing a safety switch to reduce side effects; and 3) increase persistence.” —Dr. Martin

Well, that’s it for today. For tomorrow’s first official day of ASH, our shuttle arrives at 6:30am and doesn’t return till about 10:30pm, good night.

Wishing you the best of health!

— Jack Aiello, on Twitter @JackMAiello