The fire hose is open

| Tom Swick

Here I am at the 58th American Society of Hematology (ASH) Annual Meeting and Exposition in San Diego. This is my third time at ASH. Three different cities, but some things never change: big crowds, lots of walking, and drinking from a fire hose of information.

San Diego Convention Center, the location of ASH 2016

San Diego Convention Center, the location of ASH 2016

I started with the IMF Satellite Symposium on Friday, December 2nd. The panel of experts, led by Brian G. M. Durie, MD, presented a series of case studies. The audience could vote on the best treatment option in each case, then see the experts’ choices, hear the arguments, and vote again at the end. What surprised me the most, in this embarrassingly rich era of new drugs, is the enduring preference among the experts for using autologous stem cell transplant (ASCT), or even tandem ASCT, in most cases of newly diagnosed multiple myeloma.

But there were also some hints as to where we are heading with the new treatments. Not surprisingly, given the recent new FDA approvals, Darzalex® (daratumumab) seems to be in the lead as an early treatment, in combination with either Revlimid® (lenalidomide) or Velcade® (bortezomib), and dexamethasone. The regimen of Darzalex with Pomalyst® (pomalidomide) and dex was also mentioned as a promising post-relapse therapy.

Speaking of steroids, some of you know that I’ve gone back and forth between dex and Medrol® (methyl prednisolone), and some of you may be using Medrol yourself. For the first time ever, I’ve seen Medrol listed on the charts, in a few of the presentations. There hasn’t been much discussion though, and the best opinion I could glean from anyone is that dex is “stronger.” But we already knew that.

Many of the regimens that were discussed are Velcade based. I asked whether Ninlaro® (ixazomib) could be used as a suitable substitute, and the answer is yes. Cost and convenience would be the considerations for any individual patient.

As a group, we had meetings with representatives from Amgen, Bristol-Myers Squibb, and Celgene, with Takeda yet to come. I also talked to Janssen representatives in the exhibit hall, and I am hopeful that these conversations will result in even better support for our group, and groups across the country.

Many of the regimens that were discussed are Velcade-based. I asked whether Ninlaro® (ixazomib) could be used as a suitable substitute, and the answer is yes. Cost and convenience would be the considerations for any individual patient.

While in the exhibit hall, I visited the Sanofi booth. Our favorite Journey Partners, Brian Helstein and John Killip, were not there at the time, but I learned that Sanofi is very close to recruiting patients for a phase III trial of isatuximab, their entry into the monoclonal antibody sweepstakes.

I visited every booth I could find that is involved in flow cytometry or genetic sequencing.  I was most impressed by Mayo Clinic Labs because they seem to be making the most use of these tests clinically, but I still don’t see that there is enough knowledge to lead from a genetic profile to a particular treatment. Maybe next year!

And finally, my big accomplishment. One organization has had a listing for the Orange County Multiple Myeloma Support Group, but listed Seymour and Rita Reinstein as the points of contact. Seymour, of course, passed away in 2012. Rita is in her eighties, but she has forwarded e-mail contacts to me. Until now, I’ve been unable to get this organization to correct the listing, but I walked up to their booth, and their IT person updated the page, live, while I watched!

Saturday night ended with a very successful IMF Media and Grant Awards Reception. Stay tuned to my blog #3 for impressions of that, and more!

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Tom Swick

Tom Swick is chairman of the Orange County (CA) Multiple Myeloma Support Group. He was diagnosed with IgA-lambda type myeloma in 2007 at age 54, and feels very fortunate to have maintained a stable remission for nearly nine years, using Revlimid® in various dosages and combinations. This fall, he began searching for the treatment that will provide the next nine-year remission (or CURE!). Tom keeps fit and active doing group exercise classes. He worked as a software engineer in the computer and aerospace industries, and lives in San Clemente, CA, with his wife Judy. They have three daughters. Thrilled to attend ASH again, Tom is interested in the application of new drug combinations and in the treatment of relapsed myeloma.

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