The art of treatment decisions: Pre-ASH Day

| Jack Aiello

December 2nd is actually the day before ASH officially begins, often called “Symposium” day. However, my first session was a meeting of the IMF’s Global Myeloma Action Network (GMAN). This organization started four years ago and focuses on issues such as awareness, access, and education in other countries. We share best practices such as fundraising and creating myeloma awareness. After our larger Copenhagen summertime meeting (37 members from 31 countries), our smaller pre-ASH meeting had 13 members from 7 countries. I personally learn so much at these meetings.  It’s always interesting to me how different countries face different issues. Did you know that Australia cannot us combination therapy? In the US, for example, we’re concerned with drug prices but at least the drugs are available to us . . . not so in many other countries.

The agenda for today’s GMAN meeting examined Canada’s proposed database system being implemented to capture myeloma patient information i to eventually provide more effective treatment for patients. Then doctors led discussions around: 1) the necessity to discover pre-MM biomarkers leading to the development of MM; and 2) the realization that as MM responses last longer, Quality of Life (QOL) becomes more important and necessary to measure. But are there QOL standards?

Next, I attended the IMF Symposium “Treatment Advances in Myeloma: Expert Perspectives on Translating Clinical Data to Practice.” I estimate about 1000 people attended and watched Dr. Brian Durie moderate a panel of myeloma experts. Panelists included Drs. S. Vincent Rajkumar, Shaji Kumar, Philippe Moreau, Bruno Paiva, and Jesús San Miguel. The doctors provided their insights on four questions: 1) Diagnosing MM: When Should Treatment Be Initiated? 2) Should We Be Using Risk-Adapted Therapy in Clinical Practice? 3) How Should We Use Maintenance for Patients in Clinical Practice? 4) How Do You Choose the Best Treatment Regimens for Relapsed/Refractory Disease?  The discussion was wrapped up by asking the question  “Where Are We Now and Where Are We Going With the Care of Patients With MM”?

The format was quite interesting: 1) a patient case is presented, 2) a multiple choice question is presented about one of the four topics. The audience votes their answers and results are displayed; the panel of experts previously voted and their answers are shown. Sometimes there’s disagreement between the audience and panel. Such was the case of the 42-yr old patient with high risk cytogenetics (e.g. del 17p). The audience of hematologists voted 90% for autologous stem cell transplant followed by Velcade maintenance. However, five of six experts voted tandem (!) transplant followed by Velcade maintenance. Then one or two panelists spoke on the topic, displaying evidence why the panel’s answer was correct. Then the audience voted again to see if minds were changed . . . sometimes yes, sometimes no.   However, what do you do when the expert docs split the vote 3-3? You realize that there’s still some art in the treatment decisions of our difficult cancer plus one really needs to look at the whole patient.

That’s it for today. Tomorrow’s first meeting starts with a 6:30 a.m. breakfast with the International Working Group (IMGW) to review this year’s publication recommendations and next year’s plans. Our final gathering will be at the IMF Media and Grants Award, ending at 9 p.m. In between I’ll be attending many excellent presentations.

Wishing you the best of health!

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Jack Aiello

Diagnosed with myeloma in 1995, Jack is strong proponent of patients participating in clinical trials so that, in the future, myeloma and other cancers will be known as curable diseases. He is a proud facilitator of the San Francisco Bay Area Myeloma Support Group.

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