The 2014 International Myeloma Working Group (IMWG) Annual Summit took place in Milan, Italy on June 9 and 10.

The summit is a special meeting organized by the International Myeloma Foun­da­tion in which leading myeloma researchers get to brainstorm col­lectively about the most pressing issues in the field, find ways to col­lab­o­rate, and plan future laboratory and clinical studies.

The IMWG summit is hailed by most attendees as the most important meeting for myeloma researchers worldwide. It is a unique opportunity for investigators in the field to engage in lively debate but, at the same time, learn new and often differing points of view.

All of this is important as we strive to do what is best for our patients and make further progress in the diag­nosis and treatment of multiple myeloma.

Some of the highlights of the meeting from my perspective are listed below.

1. We will be coming out with revised diagnostic criteria for myeloma that will allow earlier treatment be­fore end-organ damage.
2. The IMWG is standardizing minimal residual disease ^[1] (MRD) assessment, and a highly sensitive flow cytometry method is being prepared for implementation soon. We are glad that there is agreement in the myeloma community to move forward on this issue.
3. Dr. Antonio Palumbo of the University of Torino in Italy is leading the charge in the development of a frailty index for myeloma and specific recommendations for modification of therapy that take into ac­count a patient’s age and other health problems. Work related to such an index was presented dur­ing the most recent American Society of Hematology annual meeting (abstract ^[2] and related pre­sen­ta­tion slides ^[3]).
4. There was a lively debate on whether melphalan ^[4] (Alkeran) should remain as an option for frontline therapy given results of the recent FIRST trial. A consensus emerged that there are strong data that continue to support the use of alkylators such as melphalan in frontline therapy as part of many reg­i­mens, but cyclophosphamide ^[5] (Cytoxan), another alkylator, may be a better option for most patients when an alkylator is to be used in the frontline setting. Melphalan, however, remains a very important agent in myeloma therapy.

   (I included the results of the FIRST trial as #1 in my previous column for The Beacon, “Top 10 Dis­cov­eries Of 2013 In Multiple Myeloma ^[6].”  For more on the results of the trial, see this related Beacon ^[7] news article.)

5. There is a difference in practice between the US and Europe regarding early versus delayed stem cell transplantation. In Europe, early transplants are favored. In the US, either option is offered depending on various factors, including patient choice. A large ongoing randomized trial this is comparing early versus delayed transplant will provide answers soon in regard to this issue.
6. A number of new agents are showing promise in myeloma. These include new proteasome inhibitors (marizomib ^[8], ixazomib ^[9] (MLN9708), oprozomib ^[10] (ONX 0912)), anti-CD38 monoclonal antibodies (dara­tu­mu­mab ^[11] and SAR650984 ^[12]), elotuzumab ^[13], panobinostat ^[14], filanesib ^[15] (ARRY-520), and dinaciclib ^[16].
7. The bone working group decided to collaborate and compile data on how best to use new imaging modalities in the diagnosis and management of myeloma.
8. There is an emerging consensus that the t(4;14) subset of myeloma should be treated with Velcade (bortezomib)-based initial therapy and maintenance. In addition, the data available show that this subset of myeloma benefits from early transplantation, and we are now discussing whether selected patients may also benefit from tandem auto transplants.
9. There was a good discussion on the current status of immunotherapy for myeloma. We are looking forward to more data from ongoing trials.
10. As expected, there was a lot of discussion about the recent measles vaccine news, and my Mayo Clinic colleague Dr. Steve Russell was on hand to explain the plans moving forward. (For more regarding the measles vaccine news, see this press release ^[17] and the related discussion ^[18] in the Beacon’s forum.)
11. One of the highlights of the meeting was the presentation of the Robert A. Kyle Award to Dr. Antonio Palumbo, Dr. Palumbo has made numerous contributions to the field, including leading over 10 ran­dom­ized controlled trials -- a phenomenal accomplishment.

A lot more happened at the summit; this is just an overview. One of the best aspects of the summit is small group discussions, of which there were at least eight. I am sure a lot of new collaborations were formed at the summit. We are already looking forward to the next one!

Dr. S. Vincent Rajkumar is a professor of medicine and chair of the Myeloma Amy­loi­dosis Dysproteinemia Group at the Mayo Clinic in Rochester, Minnesota. His research focuses on clinical, epidemiological, and laboratory research for myeloma and related disorders.