By Jack Aiello
San Francisco/Greater Bay Area, CA
@JackMAiello
[email protected]

Today’s events began with a breakfast meeting for the 12 IMF support group leaders in attendance at the 56th American Society of Hematology (ASH) Annual Meeting in San Francisco. This included Teresa Miceli (nurse practitioner) who facilitates a Minnesota support group and is on the IMF Nurse Leadership Board; Jim Omel, MM patient and MD, and facilitator in Nebraska; and Debbie Birns, IMF Medical Writer (and formerly of the IMF Infoline, in case her name sounds familiar). I mention these 3 folks because all of them contributed to our 2-hour session reviewing some of yesterday’s ASH information that was missed due to conflicting meetings.

Of particular interest to me was Debbie’s review of a presentation made concerning the biology of the MM plasma cell. Using flow cytometry (a technique for measuring minimal residual disease (MRD) testing), MM plasma cells can be analyzed to determine markers they possess, specifically CD19 and CD81. The appearance of both, some, or neither of these markers might mean that flow cytometry can be used as a prognosticator.

Teresa talked about a presentation called “The Rising Cost of Medical Care: Understanding the Problem and Exploring Solutions.” One horrendous example is a daily drug called Gleevec for chronic myelogenous leukemia. When this breakthrough drug came out in 2001, the cost was $28K per year. Today that same drug costs $92K per year. The cost of medical innovation and the fair price of new medicines is a complex topic which requires urgent attention.

In both cases, Jim helped explain some of the medical terminology as well as provided an example of pharma getting paid the drug cost plus getting a tax write-off for making a donation enabling them to get paid.

There were several excellent oral presentations at ASH today:

* The ASPIRE trial comparing Kyprolis (carfilzomib)-Revlimid (lenalidomide)-dexamethasone (KRd) versus Revlimid-dexamethasone (Rd) phase III study for patients with relapsed MM showed an overall response rate (ORR) of 87% vs. 67% that included a complete response (CR) of 31% vs. 9% with the equal side effects.
* The STRATUS phase III trial examined Pomalyst (pomalidomide)-dexamethasone for 604 relapsed-refractory patients, most refractory to both Revlimid and Velcade (bortezomib). ORR was 35% with 7% achieving >= very good partial response (VGPR) while median progression free survival (PFS) and overall survival (OS) were 4.3 months and 10.9 months respectively…very good numbers for so many refractory, sick patients.
* A phase II study looked at ixazomib (oral proteasome inhibitor taken once per week)-Revlimid-dexamethasone followed by ixazomib maintenance for newly diagnosed patients achieving 52% CR, 71% >= VGPR and 100% ORR. Maintenance has continued to improve responses, increasing CR to 62%.
* Both CD38 monoclonal antibodies SAR650984 and daratumumab were combined with Revlimid-dexamethasone in separate trials and continue to look exciting.
* Using Kyprolis (70mg/m2) weekly instead of twice/week combined with Cytoxan-dexamethasone for newly diagnosed elderly patients proved just as effective as Kyprolis twice a week in an early phase II study.

One of the interesting posters showed that FISH/cytogenetics analysis should be done at relapse because high risk factors can change from diagnosis, nearly 10% of patients in this case, so FISH testing at relapse could influence subsequent treatment.

That’s it for tonight with meetings starting at 7:30 am tomorrow. Wishing you the best of success.

-Jack

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