The full program for the 2011 annual meeting of the American Society of Hematology (ASH) has become available online at the following link:
http://ash.confex.com/ash/2011/webprogram/start.html
The program includes abstracts of almost all oral and poster presentations to be given at the meeting. Furthermore, the program is searchable, making it possible to find all abstracts that mention a particular drug, disease, etc.
Abstracts that have been identified as having to do with multiple myeloma are listed on this page,
http://ash.confex.com/ash/2011/webprogram/keywordindexm.html
next to the keyword "multiple myeloma". And, yes, there are -- as usual -- lots of myeloma-related abstracts, perhaps 300 or more.
Let's use this thread to help highlight for each other which of the abstracts look particularly interesting, and why.
If you find an abstract that looks like it could be particularly important, please post the title of the presentation or poster, a link to the abstract, and perhaps a couple of quick sentences explaining why you think the presentation or poster is important or interesting.
Forums
Re: ASH 2011 Annual Meeting - Multiple Myeloma
Thanks for letting everyone know about the abstracts being available.
I've just started to go through them. However, this one definitely caught my attention:
Abstract #148 - "Achievement of Sustained Molecular Remission Induces Long-Term Freedom From Disease After Autologous-Allogeneic Tandem Transplantation in Patients with Multiple Myeloma"
http://ash.confex.com/ash/2011/webprogram/Paper42900.html
Anything that says "long-term freedom from disease" is worth looking at in more detail, right?
Here is more from the end of the abstract: "The 5 year overall survival was 52 % ... The study underlines the importance of the depth of remission and shows that achieving molecular remission ... is associated with long-term freedom from disease and potential cure of multiple myeloma in an auto-/allo SCT approach."
Yes, the authors said "potential cure."
I've just started to go through them. However, this one definitely caught my attention:
Abstract #148 - "Achievement of Sustained Molecular Remission Induces Long-Term Freedom From Disease After Autologous-Allogeneic Tandem Transplantation in Patients with Multiple Myeloma"
http://ash.confex.com/ash/2011/webprogram/Paper42900.html
Anything that says "long-term freedom from disease" is worth looking at in more detail, right?
Here is more from the end of the abstract: "The 5 year overall survival was 52 % ... The study underlines the importance of the depth of remission and shows that achieving molecular remission ... is associated with long-term freedom from disease and potential cure of multiple myeloma in an auto-/allo SCT approach."
Yes, the authors said "potential cure."
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TerryH
Re: ASH 2011 Annual Meeting - Multiple Myeloma
This abstract is about a study that's a bit small, but it's looking at a really important issue.
Abstract #4142 - "A Randomized Clinical Trial of Lenalidomide and Dexamethasone with and without Autologous Stem Cell Transplant in Patients with Newly Diagnosed Multiple Myeloma: Interim Study Results"
http://ash.confex.com/ash/2011/webprogram/Paper41262.html
It looks at the issue of whether giving patients a stem cell transplant up front is a good idea or not. They did a trial and split patients into two groups. One group got Rev and dex for a bit and then a stem cell transplant. The other grouip got just Rev and dex, but for a longer time.
The results are pointing to doing a stem cell transplant up front being the better approach.
Abstract #4142 - "A Randomized Clinical Trial of Lenalidomide and Dexamethasone with and without Autologous Stem Cell Transplant in Patients with Newly Diagnosed Multiple Myeloma: Interim Study Results"
http://ash.confex.com/ash/2011/webprogram/Paper41262.html
It looks at the issue of whether giving patients a stem cell transplant up front is a good idea or not. They did a trial and split patients into two groups. One group got Rev and dex for a bit and then a stem cell transplant. The other grouip got just Rev and dex, but for a longer time.
The results are pointing to doing a stem cell transplant up front being the better approach.
Re: ASH 2011 Annual Meeting - Multiple Myeloma
TerryH,
These type of stats relating to Allo transplants have been known for some time. I do not know why Doctors do not discuss this with their patients. I did an Allo as part of my upfront treatment. My Doctor discussed these type of Stats with me. Check out the Section titled "Molecular Remission". I will copy and paste one part. I checked the study on the 16 patients that had sustained Molecular Remissions that are discussed. They lost track of a couple of the patients, but only 1 had relapsed at 9 years of the patients that they continued to followup on.
"Another study found that in 48 patients who obtained a hematologic remission following allogeneic transplantation, 16 (33%) obtained durable PCR-negativity after transplantation, while 13 (27%) remained persistently PCR-positive, and 19 (30%) showed a mixed pattern. The cumulative risk of relapse at 5 years was 0% for PCR-negative patients, 33% for PCR-mixed patients and 100% for PCR-positive patients."
http://www.haematologica.org/content/93/9/1295.short
Mark
These type of stats relating to Allo transplants have been known for some time. I do not know why Doctors do not discuss this with their patients. I did an Allo as part of my upfront treatment. My Doctor discussed these type of Stats with me. Check out the Section titled "Molecular Remission". I will copy and paste one part. I checked the study on the 16 patients that had sustained Molecular Remissions that are discussed. They lost track of a couple of the patients, but only 1 had relapsed at 9 years of the patients that they continued to followup on.
"Another study found that in 48 patients who obtained a hematologic remission following allogeneic transplantation, 16 (33%) obtained durable PCR-negativity after transplantation, while 13 (27%) remained persistently PCR-positive, and 19 (30%) showed a mixed pattern. The cumulative risk of relapse at 5 years was 0% for PCR-negative patients, 33% for PCR-mixed patients and 100% for PCR-positive patients."
http://www.haematologica.org/content/93/9/1295.short
Mark
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Mark
Re: ASH 2011 Annual Meeting - Multiple Myeloma
Hi Mark,
I was hoping there might be something new in the study I linked to. Too bad if that's not the case.
Yes, I know that an allo transplant is the only myeloma treatment option that offers the chance at a true cure. I also am aware that the transplants are getting safer and safer.
You have to be honest, though, about the risks. Look at what it says in the article you linked to: "allogeneic transplantation in multiple myeloma is hampered by a high transplant-related mortality". The same paper says that transplant-related mortality for allo transplants reached 30-40 percent in the past.
I know that allo transplants are getting safer. But the risk of dying from the procedure not long after it's carried out is still real and not minor.
I guess your past that point now though so that's great and I hope it gives you great results for a long time.
I was hoping there might be something new in the study I linked to. Too bad if that's not the case.
Yes, I know that an allo transplant is the only myeloma treatment option that offers the chance at a true cure. I also am aware that the transplants are getting safer and safer.
You have to be honest, though, about the risks. Look at what it says in the article you linked to: "allogeneic transplantation in multiple myeloma is hampered by a high transplant-related mortality". The same paper says that transplant-related mortality for allo transplants reached 30-40 percent in the past.
I know that allo transplants are getting safer. But the risk of dying from the procedure not long after it's carried out is still real and not minor.
I guess your past that point now though so that's great and I hope it gives you great results for a long time.
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TerryH
Re: ASH 2011 Annual Meeting - Multiple Myeloma
TerryH,
It is great that this Paper is coming out and it is very informative for the rest of us that you provided a link. Most patients are unaware of the fact that Allos can perform that well. It is new research, but those patients that have Doctors that discuss Allos with their patients are better educated on the upside and downside of the procedure. The paper that will be presented above used what could be described as a MIDI Allo after the Auto. A MIDI is something that is between a MINI and a full Allo. The paper presented last year at the ASH on the Auto-Mini Allo used only Radiation as Conditioning for the Allo, a true Mini.
With the use of Novel Agents (thalidomide/Revlimid/Velcade) in combination with Autos, it is possible for multiple myeloma patients to achieve CR. Following that up with an Allo with less intensive conditioning could lead to potential cure for many multiple myeloma patients.
The 30-40% TRM rate that many discuss with Allos is old and is related to Full, myeloablative Allos. Mini is usually around 11% and full at around 20% if the full Allo is done in first Remission. The 30-40% figure includes patients that are unresponsive to Chemo, relapsed, etc. Here is another summary of a small study on full Allos. Note the last sentence. That is why you do the Allo in first Remission. None of the patients in this study entered the Allo in CR. It is no longer necessary to use myeloablative conditioning.
"Because of the repeatedly demonstrated high TRM with myeloablative conditioning, this transplant modality is now rarely used. However, recent long-term results may change this view. Kröger et al. (33) reported encouraging long-term results in a small study of 18 patients who received intensive myeloablative conditioning, including TBI, busulfan, cyclophosphamide and ATG. Transplant-related mortality was 17%, CR rate 53% and 12- yr survival 50%. For patients that entered CR, the 12-yr PFS was 60%. "
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0609.2010.01495.x/full
Mark
It is great that this Paper is coming out and it is very informative for the rest of us that you provided a link. Most patients are unaware of the fact that Allos can perform that well. It is new research, but those patients that have Doctors that discuss Allos with their patients are better educated on the upside and downside of the procedure. The paper that will be presented above used what could be described as a MIDI Allo after the Auto. A MIDI is something that is between a MINI and a full Allo. The paper presented last year at the ASH on the Auto-Mini Allo used only Radiation as Conditioning for the Allo, a true Mini.
With the use of Novel Agents (thalidomide/Revlimid/Velcade) in combination with Autos, it is possible for multiple myeloma patients to achieve CR. Following that up with an Allo with less intensive conditioning could lead to potential cure for many multiple myeloma patients.
The 30-40% TRM rate that many discuss with Allos is old and is related to Full, myeloablative Allos. Mini is usually around 11% and full at around 20% if the full Allo is done in first Remission. The 30-40% figure includes patients that are unresponsive to Chemo, relapsed, etc. Here is another summary of a small study on full Allos. Note the last sentence. That is why you do the Allo in first Remission. None of the patients in this study entered the Allo in CR. It is no longer necessary to use myeloablative conditioning.
"Because of the repeatedly demonstrated high TRM with myeloablative conditioning, this transplant modality is now rarely used. However, recent long-term results may change this view. Kröger et al. (33) reported encouraging long-term results in a small study of 18 patients who received intensive myeloablative conditioning, including TBI, busulfan, cyclophosphamide and ATG. Transplant-related mortality was 17%, CR rate 53% and 12- yr survival 50%. For patients that entered CR, the 12-yr PFS was 60%. "
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0609.2010.01495.x/full
Mark
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Mark
Re: ASH 2011 Annual Meeting - Multiple Myeloma
This is a great discussion and highlights the continuing controversy surrounding allogeneic transplants in myeloma. As you mention, fully myeloablative transplants were largely abandoned due to excessive treatment-related mortality, and the data with mini-transplants are very inconsistent, with conflicting results from different trials. So one can always pick the data they wish to believe based on his/her point of view. Nonetheless, in the largest randomized trial done to date (the BMT-CTN trial, over 700 patients) presented at ASH last year, doing a mini-allo after an initial auto transplant was compared to just doing 2 consecutive (tandem) auto transplants. There was no difference in progression-free or overall survival between the 2 groups, but the treatment-related mortality was tripled in the mini-allo group (4% to 12%), and 54% of the mini-allo group developed chronic graft versus host disease, a complication of allo transplants that can significantly impact quality of life.
So in an era when we can achieve significant rates of complete response (including PCR-negativity in some cases) with combinations of novel agent induction, auto transplant, and maintenance, most myeloma experts (though not all) feel that the upfront risks of allo transplant don't justify routine use in the majority of myeloma patients. Certianly there continue to be ongoing efforts to improve the conditioning regimen and reduce mortality, and allo transplant is still an option to consider in certain cases, but preferably in the context of a clinical trial.
So in an era when we can achieve significant rates of complete response (including PCR-negativity in some cases) with combinations of novel agent induction, auto transplant, and maintenance, most myeloma experts (though not all) feel that the upfront risks of allo transplant don't justify routine use in the majority of myeloma patients. Certianly there continue to be ongoing efforts to improve the conditioning regimen and reduce mortality, and allo transplant is still an option to consider in certain cases, but preferably in the context of a clinical trial.
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: ASH 2011 Annual Meeting - Multiple Myeloma
Dr. Cohen,
Thank you for taking the time to join in the conversation. I hope you had a chance to get out and enjoy the beautiful weather we are having in the Philadelphia area today.
I did want to point out that the study presented at ASH last year was only a 3 year study. The big thing that jumped out at me when I was looking over statistics on Allos was how the PFS curves tend to go flat after 5 years of continuous Remission. The study at ASH last year was able to fully the show the downside to Allo transplantation (more transplant-related mortality than standard treatments) but it could not show the potential upside.
I would agree that if the patient's goal is overall survival at 3 years, then an allo transplant is not an appropriate form of treatment. Also, 2 gy of radiation is good for a study to show the effectiveness of GVM vs a second round of 200 mg/m2 of melphalan, but it likely is not ideal if a doctor could select a different regimen that was individualized for each patient.
I am a bit biased. I did an auto transplant and than did an allo transplant similar to the one that Dr. Kroger and his colleagues used in the above study. The only difference was that I used more melphalan. I did come out in Molecular Remission, so I am EXCITED to see the results Dr. Kroger will be presenting.
One final note. I know someone who was treated at Fox Chase for lymphoma. She had a great experience and great results at your facility. Two Thumbs Way Up for the great work you all do there.
Mark
Thank you for taking the time to join in the conversation. I hope you had a chance to get out and enjoy the beautiful weather we are having in the Philadelphia area today.
I did want to point out that the study presented at ASH last year was only a 3 year study. The big thing that jumped out at me when I was looking over statistics on Allos was how the PFS curves tend to go flat after 5 years of continuous Remission. The study at ASH last year was able to fully the show the downside to Allo transplantation (more transplant-related mortality than standard treatments) but it could not show the potential upside.
I would agree that if the patient's goal is overall survival at 3 years, then an allo transplant is not an appropriate form of treatment. Also, 2 gy of radiation is good for a study to show the effectiveness of GVM vs a second round of 200 mg/m2 of melphalan, but it likely is not ideal if a doctor could select a different regimen that was individualized for each patient.
I am a bit biased. I did an auto transplant and than did an allo transplant similar to the one that Dr. Kroger and his colleagues used in the above study. The only difference was that I used more melphalan. I did come out in Molecular Remission, so I am EXCITED to see the results Dr. Kroger will be presenting.
One final note. I know someone who was treated at Fox Chase for lymphoma. She had a great experience and great results at your facility. Two Thumbs Way Up for the great work you all do there.
Mark
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Mark
Re: ASH 2011 Annual Meeting - Multiple Myeloma
As several people already have commented, this is a very interesting discussion about the pros and cons of allo transplants. Good stuff.
For those who may be interested, the Beacon wrote up a summary of the ASH presentation last year that Dr. Cohen referred to in his posting above. The study tested the auto-auto vs. auto-allo dual transplant approaches. The summary can be found here:
https://myelomabeacon.org/news/2010/12/06/donor-stem-cell-transplants-come-up-short-as-second-transplant-option-in-multiple-myeloma-patients-ash-2010/
People who are really interested in allo transplants also may wish to consult two additional links here at The Beacon.
First, a recent European study looking at mini allo transplants as a second transplant option:
https://myelomabeacon.org/news/2011/08/26/mini-donor-stem-cell-transplant-as-second-transplant-may-improve-outcomes-in-multiple-myeloma/
And, second, some reporting from the International Myeloma Workshop this May, which covered a presentation by Dr. Herman Einsele about allo transplants:
https://myelomabeacon.org/forum/imw-2011-multiple-myeloma-discussion-day-2-t392.html#p1507 (go down the page a bit until the part of the report about Dr. Einsele's presentation)
For those who may be interested, the Beacon wrote up a summary of the ASH presentation last year that Dr. Cohen referred to in his posting above. The study tested the auto-auto vs. auto-allo dual transplant approaches. The summary can be found here:
https://myelomabeacon.org/news/2010/12/06/donor-stem-cell-transplants-come-up-short-as-second-transplant-option-in-multiple-myeloma-patients-ash-2010/
People who are really interested in allo transplants also may wish to consult two additional links here at The Beacon.
First, a recent European study looking at mini allo transplants as a second transplant option:
https://myelomabeacon.org/news/2011/08/26/mini-donor-stem-cell-transplant-as-second-transplant-may-improve-outcomes-in-multiple-myeloma/
And, second, some reporting from the International Myeloma Workshop this May, which covered a presentation by Dr. Herman Einsele about allo transplants:
https://myelomabeacon.org/forum/imw-2011-multiple-myeloma-discussion-day-2-t392.html#p1507 (go down the page a bit until the part of the report about Dr. Einsele's presentation)
Re: ASH 2011 Annual Meeting - Multiple Myeloma
Mark and Dr. Cohen,
Thanks for the follow-up discussion related to the allo transplant abstract I posted about earlier. Since both of you already have provided a lot of follow-up information on the subject, I don't think there is much that I can add.
Getting back to the abstracts for the ASH Meeting, I'm working my way through them.
There are four related to potential new myeloma treatments that might be interesting to look at in more detail. They are:
Abstract #302 - "Phase 1 Clinical Evaluation of Twice-Weekly Marizomib (NPI-0052), a Novel Proteasome Inhibitor, in Patients with Relapsed/Refractory Multiple Myeloma"
http://ash.confex.com/ash/2011/webprogram/Paper37217.html
Abstract #303 - "A Phase 2 Study of Elotuzumab in Combination with Lenalidomide and Low-Dose Dexamethasone in Patients with Relapsed/Refractory Multiple Myeloma"
http://ash.confex.com/ash/2011/webprogram/Paper36976.html
Abstract #304 - "304 Combination of Bendamustine, Lenalidomide, and Dexamethasone (BLD) in Patients with Refractory or Relapsed Multiple Myeloma Is Safe and Highly Effective: Results of Phase I/II Open-Label, Dose Escalation Study"
http://ash.confex.com/ash/2011/webprogram/Paper41680.html
Abstract #305 - "BT062, An Antibody-Drug Conjugate Directed Against CD138, Shows Clinical Activity in Patients with Relapsed or Relapsed/Refractory Multiple Myeloma"
http://ash.confex.com/ash/2011/webprogram/Paper42689.html
Thanks for the follow-up discussion related to the allo transplant abstract I posted about earlier. Since both of you already have provided a lot of follow-up information on the subject, I don't think there is much that I can add.
Getting back to the abstracts for the ASH Meeting, I'm working my way through them.
There are four related to potential new myeloma treatments that might be interesting to look at in more detail. They are:
Abstract #302 - "Phase 1 Clinical Evaluation of Twice-Weekly Marizomib (NPI-0052), a Novel Proteasome Inhibitor, in Patients with Relapsed/Refractory Multiple Myeloma"
http://ash.confex.com/ash/2011/webprogram/Paper37217.html
Abstract #303 - "A Phase 2 Study of Elotuzumab in Combination with Lenalidomide and Low-Dose Dexamethasone in Patients with Relapsed/Refractory Multiple Myeloma"
http://ash.confex.com/ash/2011/webprogram/Paper36976.html
Abstract #304 - "304 Combination of Bendamustine, Lenalidomide, and Dexamethasone (BLD) in Patients with Refractory or Relapsed Multiple Myeloma Is Safe and Highly Effective: Results of Phase I/II Open-Label, Dose Escalation Study"
http://ash.confex.com/ash/2011/webprogram/Paper41680.html
Abstract #305 - "BT062, An Antibody-Drug Conjugate Directed Against CD138, Shows Clinical Activity in Patients with Relapsed or Relapsed/Refractory Multiple Myeloma"
http://ash.confex.com/ash/2011/webprogram/Paper42689.html
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TerryH
17 posts
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