Friday was the last day of the International Myeloma Workshop (IMW) in Paris.  The agenda for the day was briefer than the previous days of the conference.  Talks ran from the early morning through mid-afternoon.

The morning began with a session in which myeloma specialists presented consensus reports on vaccination and infection prevention, the management of anemia, blood clots in deep veins, and bone disease.  The Myeloma Beacon will be covering these reports in more detail over the next few weeks.

Throughout the rest of the morning, researchers presented results from ongoing clinical trials.  Highlights from this session will be described in the rest of this article.

The workshop concluded in the afternoon with a closing ceremony and cocktail reception.  During this time, it was announced that the next IMW will be held in Kyoto, Japan, April 3 through 6 of 2013.

Myeloma Genome Mapping

During the first presentation of the session, Dr. P. Andrew Futreal of the Sanger Institute in Cambridge, United Kingdom, talked about the work that led to the mapping of the myeloma genome.  He spoke about how it was done and some of the initial learnings.  As work that is very recent and still evolving, it will not have any immediate effects on the treatment of myeloma patients.

Preventing Blood Clots

Next, Dr. Federica Vacallo of the University of Turin, Italy, presented results from a clinical trial comparing the use of Lovenox (enoxaparin) and aspirin to prevent blood clotting in patients receiving Revlimid (lenalidomide).

The study included 400 newly diagnosed myeloma patients who were treated with Revlimid before and after receiving a stem cell transplant.  Half of the participants also received Lovenox during their Revlimid therapy, and the other half received aspirin.

Aspirin and Lovenox both effectively prevented blood clots in almost all patients, with 2.3 percent and 1.2 percent of patients, respectively, experiencing a serious blood clot during treatment.  Blood clots that did occur usually developed during the early part of treatment (median 1.3 months after initiation of Revlimid therapy).

Dr. Cavallo recommended that all patients should take medication during the first four to six months of Revlimid treatment to prevent blood clots.  For patients who are at high risk of developing a blood clot, Dr. Cavallo recommended Lovenox.

Minimal Residual Disease

Dr. Roger Owen of St. James University Hospital in Leeds, United Kingdom, spoke about minimal residual disease, which is the presence of some myeloma cells in a patient even when traditional blood tests that monitor myeloma proteins indicate a complete response to treatment.

In a clinical trial including 1,211 myeloma patients, Dr. Owen and his colleagues used a technique called multiparameter flow cytometry to test for residual disease.  The results showed that progression-free survival was significantly longer for patients without any residual disease (39 months compared to 21 months for patients with minimal residual disease).

The results also showed that thalidomide (Thalomid)-containing induction and maintenance regimens were more effective at helping patients eliminate any residual disease, compared to other regimens used in the trial that did not contain any novel agents.

As compared to standard measures of response, flow cytometry was particularly helpful in predicting outcomes for standard-risk patients.

PET/CT Scans For Predicting Survival

Next, Dr. Elena Zamagni of the University of Bologna, Italy, spoke about the extent to which the results of PET/CT scans of myeloma patients correlate with progression-free and overall survival.

Dr. Zamagni and her colleagues retrospectively analyzed data from 192 newly diagnosed myeloma patients who were given PET/CT scans at diagnosis, following induction therapy, and after stem cell transplantation.

They found that the number of bone lesions detected in the scan, the “standardized uptake value” calculated during the scan (a measure of tumor growth), and the presence of extramedullary disease (myeloma tumor growth outside of the bone marrow) were all correlated with patient survival.  They also found, however, that the presence of extramedullary disease and unfavorable chromosomal abnormalities at diagnosis were the strongest predictors of survival.  Results from PET/CT scans done after transplantation, however, gave very similar responses as standard testing for myeloma proteins in the blood.

Velcade Consolidation Therapy

The next presentation was given by Dr. Ulf Mellqvist of the Sahlgrenska University Hospital in Gothenburg, Sweden.  His study, which included 370 myeloma patients, examined the use of Velcade (bortezomib) as consolidation therapy after stem cell transplantation.

The patients who received Velcade consolidation therapy achieved a significantly higher proportion of complete or near complete responses compared to those who did not receive consolidation (45 percent compared to 35 percent, respectively).  They also had significantly longer progression-free survival (27 months compared to 20 months, respectively).  Overall survival, however, was 87 percent for both groups after a median follow-up of 27 months.

In terms of side effects, there were no significant blood-related side effects.  However, patients who received Velcade consolidation were more likely to develop peripheral neuropathy (pain and tingling in the extremities).

Pomalidomide

Dr. Paul Richardson from the Dana-Farber Cancer Institute presented results from the Phase 1/2 trial studying pomalidomide (CC-4047) alone or in combination with low-dose dexamethasone (Decadron) in relapsed and refractory myeloma patients.  This study was previously presented at the American Society of Hematology meeting in December, so please see the related Beacon news for a summary of the results.

Carfilzomib

Then Dr. David Siegel from the John Theurer Cancer Center presented results from the Phase 2b clinical trial studying carfilzomib in relapsed / refractory myeloma patients.  This study was also previously presented at the American Society of Hematology meeting in December, so the results can be found in a related Beacon news article.

Changes In Myeloma Death Rates Over Recent Years

The final presentation of the session was given by Dr. Edward Libby of the University of New Mexico Cancer Center.  Dr. Libby’s study looked at the death rates among myeloma patients in the United States over the past 40 years to determine whether recent treatment advances have had an impact on them.

For patients younger than 65 years, the death rate steadily increased from 1970 to 1995 and then significantly dropped.  Dr. Libby and his colleagues believe that the use of stem cell transplants in the 1980s and 1990s, thalidomide in the early 2000s, and subsequently the other novel agents likely account for the declining death rate in this group of patients starting in 1995.

For patients 65 years and older, there was an even steeper increase in death rates until 1993, when rates leveled off until 2002, and then began to decline.  Since a limited number of older myeloma patients typically receive stem cell transplants, Dr. Libby said that the flattening of death rates in the 1990s is more difficult to explain but may be due to improvements in supportive care during that time.  The improvement in death rates after 2002 is almost certainly due to increasing use of novel myeloma therapies in older patients.

For more detailed summaries of the day’s sessions, see The Myeloma Beacon’s extensive Day 4 coverage in the Beacon forums.  For links to abstracts of the presentations, see the IMW programme.