[RadiantTiger]

Mayo Clinic article on diagnosis & treatment (2016)

by RadiantTiger on Mon Jan 11, 2016 10:14 pm

Good article in outlining various treatments for multiple myeloma:

SV Rajkumar and S Kumar, "Multiple Myeloma: Diagnosis and Treatment," Mayo Clinic Proceedings, January 2016 (full text of article - html, full text of article - PDF)

[JPC]

Re: Mayo Clinic article on diagnosis & treatment (2016)

by JPC on Mon Jan 11, 2016 10:46 pm

Hello RT:

This is an excellent article that I had not seen before. I scanned it, but need to go through it in detail. Thank you very much for posting. All the best.

[RadiantTiger]

Re: Mayo Clinic article on diagnosis & treatment (2016)

by RadiantTiger on Mon Jan 11, 2016 11:40 pm

Yes, it provides a good basis to ask questions of our doctors – about treatment options, and why they prefer treatment X over treatment Y.

RT

[goldmine848]

Re: Mayo Clinic article on diagnosis & treatment (2016)

by goldmine848 on Tue Jan 12, 2016 10:05 pm

Thank you RT. Excellent article.

[Multibilly]

Re: Mayo Clinic article on diagnosis & treatment (2016)

by Multibilly on Wed Jan 13, 2016 3:53 pm

RT,

This truly is a great and comprehensive article. Folks should point new folks on the forum to this article, as it covers a lot of ground and subjects with respect to multiple myeloma in a nice single document ... and it is up to date.

Thanks!

[KarenaD]

Re: Mayo Clinic article on diagnosis & treatment (2016)

by KarenaD on Wed Jan 13, 2016 7:09 pm

Radiant Tiger,

Thanks so much for posting this most informative article.

Since I'm on VCD in preparation for my upcoming autologous stem cell transplant, I was a little disconcerted to note that:

A recent randomized trial also found that the triplet regimen of VTD, which contains a proteasome inhibitor (bortezomib) and an immunomodulatory agent (thalidomide), is superior to VCD (Table 9).62 On the basis of these data, VRD or VTD are the preferred regimens for initial therapy in transplant-eligible patients and in fit transplant-ineligible patients.

I have a feeling, though, that my doctor has me on VCD instead of VTD as I may get a better yield of stem cells on this regimen. Stem cell yield could be a concern for me because of my past chemotherapy treatment for an unrelated cancer.

Again, excellent article.

Karen

[JPC]

Re: Mayo Clinic article on diagnosis & treatment (2016)

by JPC on Thu Jan 14, 2016 9:20 am

Hi KarenaD:

The topic of RVD vs CyBorD (aka VCD) has been discussed frequently, and I have posted on this before. The Mayo Clinic only updated its MSmart in early December to move to RVD away from CyBorD for newly diagnosed, standard-risk multiple myeloma. Only in the latest ASH meeting in December was it established by enough data that the IMID-PI combo has a little bit better overall survival than CyBorD, which uses an alkylator instead of an IMID (Rev or thalidomide).

So I would not worry, and just move on. When you started induction, it was probably the case that it was your center's best option (sometimes called standard of care). Going forward, I would suggest researching the concepts of consolidation and maintenance, and discussing with your doctors (these are issues that were not included in the study, by use of consolidation and maintenance, you may probably do better, potentially, than either arm of that study).

Interestingly, the most popular option for maintenance is Revlimid, which they could very well possibly give you, even though you did not have it in initial induction. Also, if you are tolerating your treatment well, a new concept, not yet completely borne out by clinical trials, is to treat to MRD negativity. Finally, for down the road, there are newer and better drugs for relapse, which hopefully you will not need for a long time.

Good Luck, JPC

[KarenaD]

Re: Mayo Clinic article on diagnosis & treatment (2016)

by KarenaD on Thu Jan 14, 2016 6:39 pm

Hi JPC,

Thanks for your feedback and pointers regarding consolidation and maintenance. Lots of new topics for discussion with my doctors going forward.

All the best,
Karen

[mikeb]

Re: Mayo Clinic article on diagnosis & treatment (2016)

by mikeb on Sat Jan 16, 2016 2:28 pm

Thanks, Radiant Tiger, for letting us know about this new article. I finally got a chance to read it last night. It seems to be an excellent summary of the state of the art in multiple myeloma diagnosis and treatment. No doubt it will be an important and influential paper.

For me, it was interesting to read Mayo's take on so many of the different topics that we've discussed here in the Forum over the past few years. It was also interesting to see how treatment recommendations have changed recently.

I was diagnosed and began treatment three years ago. Here are some of the changes during that time that stood out to me from reading the article:

1. More emphasis on driving to the deepest initial response possible, especially through the use of novel agents and triplet combinations.
2. More use of maintenance therapy in front-line treatment, both with Revlimid and Velcade. And longer duration of maintenance therapy, especially with Revlimid.
3. Velcade lite and dex lite in VRD induction treatment - once a week for both Velcade and dex. No doubt that is helping to make the induction phase easier for many patients. When I was going through induction, I wondered, for example, how they knew that the best thing to do was give me Velcade on days 1,4,8, and 12 of the 3 week cycle. Now I see that they didn't really "know" that at all. There's sometimes more art than science to this stuff.
4. We seem to be in the early stages in the use of Kyprolis as an induction therapy agent, such as with KRD. I wonder if we will see pomalidomide move into the mainstream as an induction agent too.
5. Increased use of testing for MRD to help direct treatment decisions. This is closely related to #1 above.
6. Several new agents, including the four that were approved in 2015, for use in relapsed and refractory cases. It's encouraging that these new drugs are now out of the pipeline and into the clinics. And, of course, encouraging that there are even newer drugs in the pipeline.

However, there is one area where things seem to have not changed all that much. Despite the advances, the median overall survival (OS) time cited in the article is only 5-7 years. When I began treatment three years ago, in answer to my inevitable question, my doctor said a median of 9 years even before my FISH results were in. So it seems he was more optimistic then than the folks at Mayo are now. At any rate (and realizing that none of us are "the median"), it's discouraging that we are still looking at such stark OS numbers.

My two cents ...

Mike

[RadiantTiger]

Re: Mayo Clinic article on diagnosis & treatment (2016)

by RadiantTiger on Mon Jan 18, 2016 1:01 am

Hi Mike,

Yes, for all the excitement over new and better drugs being approved, it seems the improvements are always measured in months and not years. While it's good that there are more drug options, especially for those with late-stage myeloma who are running out of options, there are no magic bullets yet.

RT