Officially, the 56th American Society of Hematology (ASH) Annual Meeting started on Saturday, December 6, 2014. But, the day before showcased the IMF’s Satellite Symposium highlighting the need to provide customized best options for myeloma treatment.
Ola Landgren MD, PhD, (Memorial Sloan Kettering Cancer Center) and S. Vincent Rajkumar, MD, (Mayo Clinic) sparred around the need to treat high-risk smoldering myeloma. Rajkumar argued with the updated ISS staging system, there is no need to treat high-risk smoldering myeloma as ultra-high-risk is now considered myeloma and there is already agreement it needs to be treated. They both agreed any treatment of high-risk smoldering myeloma needs to be in a clinical trial setting.
The discussion then went to the benefit of minimal residual disease (MRD) based decision making for treating myeloma. Shaji Kumar, MD, (Mayo Clinic) argued that today MRD testing doesn’t have low enough sensitivity and there is no agreed upon standardization in the field, and MRD-zero should be considered holistically.
During the “to maintain or not to maintain” debate, Dr. Rajkumar got applause for saying, “we want our patients to live WITH myeloma and not FOR myeloma.” Later on he added, “When outcome is not certain, physicians shouldn’t be dogmatic and should consider the overall circumstance of the patient.”
During the final debate, Dr. Kumar and Dr. Landgren discussed the clonal evolution of myeloma and how that makes treatment/control more elusive. At the conclusion, Dr. Landgren stated that we need to find more effective, less intense treatment for myeloma.
On a side comment, Dr. Durie mentioned that understanding the biology of myeloma is critical to make breakthrough progress in myeloma.
My takeaways from the debate:
• while there is some level of uncertainty how to deal with any individual myeloma case, there seems to be more treatment consensus than previous years
• but that’s complicated with the availability of novel therapies
• quality of life and overall patient circumstance seems to be considered as physicians decide treatment
• there is agreement that as myeloma understanding evolves, so should the approach to identify, stage and treat the patients
• it was clear that clinical trials are endorsed and encouraged by the debaters
Sharing the HOPE!
Yelak from North Texas Myeloma Support Group!