High-Risk Smoldering Myeloma: Defining It and Moving Forward

Email this program

Get Link

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello and welcome to Patient Power. I’m Andrew Schorr. Well there was a big meeting in Boston recently called Myeloma 2014. It brought together world experts in myeloma to discuss the latest. As some people know, the hot issue is all about so-called smoldering myeloma. One expert who has been studying it is Dr. Ola Landgren from Memorial Sloan-Kettering in New York City. He joins us to explain the latest.

Dr. Landgren:

I was in the morning session led by Dr. San Miguel. We were three speakers. The first two speakers were focusing on studies trying to characterize the biology of early disease. And they showed evidence of more and more adverse biological features from early stages into symptomatic multiple myeloma. I think what was striking was that a lot of those molecular characteristics that we now can see in multiple myeloma, many of them are present both in MGUS and in smoldering myeloma, but there seems to be more of them as the disease becomes symptomatic. What we do not know at this point is which of these normalities, which really change from an asymptomatic to a symptomatic state of disease. That is currently not known.

The third talk was by myself. I was talking about the natural history of smoldering myeloma. I tried to cover some of the basic concepts, that are based on follow-up, without therapy, and I tried to shed light on the concept of high-risk versus low-risk smoldering myeloma. I tried to emphasize the fact that most of those studies that talk about high risk, they are retrospective small studies, and there are really no comparison studies between these different models. I think that’s problematic from where we are right now. If we assign an individual patient as being high risk by one model, do we know for sure that that is high risk by another model? The reason I think that it is important is because if you’re going to treat high-risk smoldering myeloma, we want to make sure that person actually is at high risk of transforming disease. We don’t want to overtreat people who have more MGUS-like disease.

Also in my presentation, I talked about what we really know about treating high-risk smoldering myeloma based on those models. I showed results from the Spanish group that were published in 2013 in the New England Journal of Medicine. They obtained a complete response rate in 14 percent of patients after they had given the nine cycles of lenolidomide (Revlimid) and dexamethasone (Decadron). And they also showed when they continued to give maintenance or extended dosing with lenalidomide that the number of patients that had a deepened response continued to go up. So it suggests that if you continue therapy, that the therapy is actually taking the disease further and further down. They showed in that study they published that both progression-free and overall survival was beneficial if you were treated versus you were just followed passively.

The last part I showed in my presentation, was a study that I had designed, together with my colleagues, using the same two drugs, Revlimid and dexamethasone, and I added carfilzomib (Kyprolis). We gave eight cycles of that therapy and after that, all patients were put on lenalidomide maintenance, for extended dosing. And in that study, we showed, based on preliminary data, that out of the first 12 patients that were treated, all the 12 have reached a complete response. Actually, 11 of them are now stringent complete response. We also show minimal residual disease assays being negative in 11 out of 12 patients. So those results were very provocative and extremely good.

So there was a discussion after these presentations. What does it mean when we study the molecular markers? Is there a way to carve out high-risk disease using all these new, fancy assays? And I don’t think we could really come up with one way of doing it. So we need to do more research.

Also, there was a discussion about, if we treat patients that we believe are high risk, what’s the best way of doing it? Based on what I told you, the results look very promising if you use three drugs. Although I was the lead PI for the study, my comment was that this is early on. We need long-term follow-up. We probably need a larger series of patients being treated on trials. So my take as a PI on this study is that I would like to see more patients being very carefully monitored on clinical trials before this becomes the standard of care. But it looks very promising.

Andrew Schorr:

We’ll be sure to keep you updated on the latest when it comes to smoldering myeloma. Be sure to be signed up for email alerts on the website so we can let you know whenever we post something new. I’m Andrew Schorr. Remember, knowledge can be the best medicine of all.         

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

 

Featured Blog
Navigating Cancer Faster

By Andrew Schorr


Page last updated on May 29, 2014