This forum thread can be used to discuss the proceedings of the American Society of Hematology (ASH) meeting that take place on Day 3 (Monday, December 6) of the conference. Feel free to use this space to highlight interesting abstracts, summarize the presentations as they happen, ask questions, and discuss any relevant topics. Everyone is encouraged to participate.
Feel free to also check out the discussions for Day 1, Day 2, and Day 4.
Forums
Re: ASH 2010 Multiple Myeloma Discussion - Day 3
This morning's session started bright and early at 7 a.m. There were 6 talks about therapy, but there was a wide range of topics including induction therapy, optimization of dosing and administration, overcoming high risk myeloma, maintenance therapy, and bone disease.
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Julie Shilane - Name: Julie Shilane, Beacon Staff
Re: ASH 2010 Multiple Myeloma Discussion - Day 3
The first talk was given by Dr. Laura Rosinol. She presented a study comparing three induction regimens prior to stem cell transplantation. The three regimens included:
Side effects were similar among the three options, with the notable exception that 12% of VTD patients experienced peripheral neuropathy compared to 1% in the other groups.
- VBMCP/VBAD/Velcade (QT+V) – See the clinical trial description for more information about this regimen
- Thalidomide/dexamethasone (TD)
- Velcade/thalidomide/dexamethasone (VTD)
Side effects were similar among the three options, with the notable exception that 12% of VTD patients experienced peripheral neuropathy compared to 1% in the other groups.
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Julie Shilane - Name: Julie Shilane, Beacon Staff
Re: ASH 2010 Multiple Myeloma Discussion - Day 3
Dr. David Vesole presented an analysis of Revlimid plus low or high dose dexamethasone (RD and Rd) by age group. The initial analysis of this study was published in 2009 (see related Beacon news), showing that survival was better in the group of patients receiving low-dose dexamethasone and changing the standard for treating myeloma patients.
Older patients receiving RD began progressing much faster than younger patients. Patients less than 65 years of age achieved better responses to RD treatment, but it did not translate into better PFS or overall survival. No group showed a superior outcome with RD, but side effects were higher.
Older patients receiving RD began progressing much faster than younger patients. Patients less than 65 years of age achieved better responses to RD treatment, but it did not translate into better PFS or overall survival. No group showed a superior outcome with RD, but side effects were higher.
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Julie Shilane - Name: Julie Shilane, Beacon Staff
Re: ASH 2010 Multiple Myeloma Discussion - Day 3
Dr. Maria-Victoria Mateos presented an analysis of a study. Half of the patients received VMP induction, the other half received VTP induction. Half of each of those groups then received maintenance with VT, while the other half received maintenance with VP. The analysis Dr. Mateos presented looked at how high risk patients with chromosomal abnormalities or extra chromosomes responded.
Responses, although lower for high-risk patients (with chromosomal abnormalities), were statistically similar. However, PFS was worse in high-risk patients, and this difference was particularly pronounced after maintenance therapy. Additionally, the type of induction therapy did not affect the PFS. Overall survival was 38 months for the high-risk group and not yet reached for standard-risk patients.
Response and PFS were similar regardless of whether patients had extra chromosomes. However, overall survival was higher among patients with extra chromosomes.
Responses, although lower for high-risk patients (with chromosomal abnormalities), were statistically similar. However, PFS was worse in high-risk patients, and this difference was particularly pronounced after maintenance therapy. Additionally, the type of induction therapy did not affect the PFS. Overall survival was 38 months for the high-risk group and not yet reached for standard-risk patients.
Response and PFS were similar regardless of whether patients had extra chromosomes. However, overall survival was higher among patients with extra chromosomes.
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Julie Shilane - Name: Julie Shilane, Beacon Staff
Re: ASH 2010 Multiple Myeloma Discussion - Day 3
Dr. Michel Attal presented the final data from his trial comparing Revlimid maintenance versus placebo after stem cell transplantation. Interim results were presented at ASCO (IFM study).
Patients underwent a stem cell transplant, received Revlimid consolidation, and half received Revlimid maintenance and half received a placebo.
Revlimid consolidation improved responses and PFS compared to transplantation alone. Maintenance did not significant increase the number of patients who achieved CR. However, 4 years after diagnosis, PFS was 60% for the Revlimid maintenance group compared to 33% for the placebo group. This difference was seen even if patients achieved a CR after induction, showing the importance of maintenance even if they achieve a good response after initial treatment. Overall survival was similar, though, for those receiving Revlimid maintenance or placebo.
Dr. Attal said that longer follow-up is needed to appreciate the impact on overall survival. However, he said that the better PFS is a huge improvement in quality of life, and he said, “I’m convinced some of these patients will be cured.”
During the Q&A session, a physician in attendance said, “Revlimid maintenance is likely to become a new standard.” Although, another physician was more skeptical and wanted to see a difference in overall survival, since maintenance therapy causes more side effects and costs more.
Patients underwent a stem cell transplant, received Revlimid consolidation, and half received Revlimid maintenance and half received a placebo.
Revlimid consolidation improved responses and PFS compared to transplantation alone. Maintenance did not significant increase the number of patients who achieved CR. However, 4 years after diagnosis, PFS was 60% for the Revlimid maintenance group compared to 33% for the placebo group. This difference was seen even if patients achieved a CR after induction, showing the importance of maintenance even if they achieve a good response after initial treatment. Overall survival was similar, though, for those receiving Revlimid maintenance or placebo.
Dr. Attal said that longer follow-up is needed to appreciate the impact on overall survival. However, he said that the better PFS is a huge improvement in quality of life, and he said, “I’m convinced some of these patients will be cured.”
During the Q&A session, a physician in attendance said, “Revlimid maintenance is likely to become a new standard.” Although, another physician was more skeptical and wanted to see a difference in overall survival, since maintenance therapy causes more side effects and costs more.
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Julie Shilane - Name: Julie Shilane, Beacon Staff
Advances/Target information
Julie, I follow intensively the information about lymphoma. There - in this relative field - has been made many discovery in "target information and genetics". Did you her about this topic also - has there been made advances in identification of new targets for myeloma therapy? And another topic I'm interested in is radiation? This was a big topic last year in one or two discussions. Did you her something about this? Best regards and thank you, Tom
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Tom L.
Re: ASH 2010 Multiple Myeloma Discussion - Day 3
Thank you Julie for the great summary of Dr. Attal's talk covering the long term study for lenalidomide-only maintenance this morning.
This morning it was also important to see the abstract presented by Dr. Elena Zamagni that focused on the PET scan's importance in terms of understanding the prognostic value. The study clearly shows the importance of doing a PET CT at diagnosis, after induction (prior to ASCT), and after ASCT. The conclusions:
- Persistence of high tumor metabolism detected by PET/CT after induction therapy predicts worse outcome in terms of TTP, PFS, and OS
- Complete FDG suppression after ASCT is prognostically relevant for durable disease control and longer OS.
- FDG-PET/CT involvement at the time of relapese confirms reduced OS due to shortened survival post relapse.
This morning it was also important to see the abstract presented by Dr. Elena Zamagni that focused on the PET scan's importance in terms of understanding the prognostic value. The study clearly shows the importance of doing a PET CT at diagnosis, after induction (prior to ASCT), and after ASCT. The conclusions:
- Persistence of high tumor metabolism detected by PET/CT after induction therapy predicts worse outcome in terms of TTP, PFS, and OS
- Complete FDG suppression after ASCT is prognostically relevant for durable disease control and longer OS.
- FDG-PET/CT involvement at the time of relapese confirms reduced OS due to shortened survival post relapse.
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aliarsan - Name: Ali Arsan
Re: ASH 2010 Multiple Myeloma Discussion - Day 3
News from the ASH meeting is moving the financial markets today.
In particular, the results of the CALGB and IFM Revlimid maintenance trials have driven down Celgene's stock today about 10 percent.
The reason? As we have reported already, data from the Revlimid maintenance trials indicate that there *may* be an increased risk of patients on Revlimid maintenance therapy developing other cancers in addition to their myeloma. Financial analysts are concerned that the potential risk of "secondary cancer", as it's called, may reduce the number of patients being treated with Revlimid, thus hurting Celgene's financial performance.
Celgene spokespeople and some physicians, however, are saying that the trial results are being misinterpreted, and that Revlimid does not create an additional risk of secondary cancer.
We are looking into this in more detail, and will publish more on the matter as soon as we can present a more thorough analysis of the data.
In particular, the results of the CALGB and IFM Revlimid maintenance trials have driven down Celgene's stock today about 10 percent.
The reason? As we have reported already, data from the Revlimid maintenance trials indicate that there *may* be an increased risk of patients on Revlimid maintenance therapy developing other cancers in addition to their myeloma. Financial analysts are concerned that the potential risk of "secondary cancer", as it's called, may reduce the number of patients being treated with Revlimid, thus hurting Celgene's financial performance.
Celgene spokespeople and some physicians, however, are saying that the trial results are being misinterpreted, and that Revlimid does not create an additional risk of secondary cancer.
We are looking into this in more detail, and will publish more on the matter as soon as we can present a more thorough analysis of the data.
Re: ASH 2010 Multiple Myeloma Discussion - Day 3
Hi Tom,
There are several myeloma talks going on simultaneously throughout the day. So I have been attending and reporting on the ones that I think will be interesting for the most patients. There are tracks for therapeutic targeting, biology and physiology of myeloma, preclinical results, clinical trial results, etc. You may wish to check out the abstracts for the first few tracks I just mentioned. All of the abstracts are available on the ASH website: http://ash.confex.com/ash/2010/webprogram/start.html I'd recommend viewing the schedule by day or searching for specific key words. Please feel free to post anything here that you think others may find interesting!
Hi Ali,
Thanks for attending and reporting on Dr. Zamagni's talk!
There are several myeloma talks going on simultaneously throughout the day. So I have been attending and reporting on the ones that I think will be interesting for the most patients. There are tracks for therapeutic targeting, biology and physiology of myeloma, preclinical results, clinical trial results, etc. You may wish to check out the abstracts for the first few tracks I just mentioned. All of the abstracts are available on the ASH website: http://ash.confex.com/ash/2010/webprogram/start.html I'd recommend viewing the schedule by day or searching for specific key words. Please feel free to post anything here that you think others may find interesting!
Hi Ali,
Thanks for attending and reporting on Dr. Zamagni's talk!
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Julie Shilane - Name: Julie Shilane, Beacon Staff
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