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

Here’s my preliminary summary of the 56th American Society of Hematology (ASH) Annual Meeting, and I emphasize “preliminary” because I’ll be learning more about the interpretation of ASH 2014 results as I listen to follow-up presentations by MM expert oncologists over the next 1-2 months. That said, there didn’t appear to be any blockbuster announcements for myeloma patients. Rather, I saw many posters and oral presentations that focused on potential myeloma and bone marrow microenvironment markers as treatment targets for which drugs should be developed and may very well become future blockbusters.

In terms of current treatments and new drugs, I was impressed by the following:

* Kyprolis (Carfilzomib) combined with Revlimid (lenalidomide) and dexamethasone (KRd) in the ASPIRE phase III trial for relapsed MM patients showed a high overall response rate (ORR) of 81% with a notably high complete response (CR) of 31%.
* Pomalyst (pomalidomide) combined with dexamethasone and another drug such as Velcade (bortezomib), Cytoxan, or Kyprolis are effective combinations
* Monoclonal antibodies (mAbs) daratumumab, SAR650984, and elotuzumab are all making their way through trials and will provide patients with another functional area (besides IMiDs and proteasome inhibitors) of treatment.
* Ixazomib and oprozomib are new oral proteasome inhibitors (PI) that are being examined as both initial as well as maintenance treatment options.
* Ibrutinib (recently approved for chronic lymphocytic leukemia and mantle cell lymphoma) and LGH447 are both showing single-agent activity in relapsed/refractory MM patients.

Studies continue to be on the front end and back end of MM patients. On the front end, specifically smoldering multiple myeloma (SMM), “ultra high-risk” (plasma% > 60%, free light chain ratio > 100 or focal lesions > 1) has now been reclassified by the International Myeloma Working Group (IMWG) as full-blown MM…meaning that contrary to the previous “watch-and-wait” recommendation, this asymptomatic patient should now be treated as any MM patient. Further, more studies are being done on “high-risk” SMM patients to determine if earlier treatment benefits them.

On the back-end of treatment, maintenance continues to be investigated and more and more MM experts seem to agree that maintenance to progression is best. With future oral PIs, patients will have several oral maintenance options.

Maybe the best news for MM patients is that more attendees (26,000) than ever came to ASH 2014, meaning that more community clinicians are educated about the newest myeloma research and study results. Further, 855 myeloma abstracts means that myeloma research is continuing at a fast pace so that we patients can continue to expect myeloma treatment progress.

My recommendations to you are to stay educated and consider participation in clinical trials because that is how myeloma treatments are advanced. Wishing all of you the best of success.

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