Linda Huguelet
Chattanooga, Tennessee

Today’s events focused on continuing education opportunities for the practicing hematologists who traveled to San Francisco for the 56th American Society of Hematology (ASH) Annual Meeting. The International Myeloma Foundation (IMF) partnered with Clinical Care Options ( to present a point-counterpoint satellite symposium debate on four key topics that face clinicians today. The session was overflowing with more than 800 physicians who were eager to stay up-to-date on the best practices that will help them offer the best care to their myeloma patients.

As we all know, the world of myeloma is ever-changing and today’s forum gave practicing hematologists exposure to a stellar faculty from top U.S. institutions such as Mayo Clinic and Memorial Sloan Kettering Cancer Center, along with two key researchers from Spain and Italy. The faculty debated some key situations that are seen in the audiences’ practices. Dr. Durie moderated the event, which allowed the audience the opportunity to vote on how they’d handle each patient scenario. Votes were taken before and after each debate; it was interesting to see if the debate changed the minds of those in the audience.  How to handle high-risk smoldering patients was the debate that changed the most minds. After the debate 77% (up from 60%) agreed they would opt to observe versus treat. Other topics included how to incorporate minimal residual disease (MRD) in treatment selection, best approaches to relapsed/refractory patients and whether maintenance should be the standard approach. You can see the entire program on the IMF’s website – be sure to check it out at

Reporting on maintenance therapy is one of my focuses at this year’s conference, so I was especially interested in this segment. All on the panel agreed that patients with intermediate and high-risk factors benefit the most from continuous treatment. There was some disagreement on the topic for standard-risk patients who don’t exhibit any of the more difficult chromosomal translocations or deletions. Toxicities and cost were also part of the discussion. I thought Dr. Vincent Rajkumar from Mayo Clinic said it best — patients need to live with myeloma instead of living for myeloma. I can speak from personal experience that maintenance treatment can affect your quality of life, so every patient has to weigh the pros and cons based on their own personal situation. Like so many of the myeloma treatment issues we face, they are not ‘cut and dry’ decisions. Research on maintenance continues to show that it can increase the amount of time to progression of the disease, but whether it increases overall survival can still be debated.

As the conference kicks off on Saturday, there will be much more discussion about maintenance and the latest studies on this topic will be presented. Be sure and check out my upcoming posts for more information on this important treatment decision.

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