Multiple Myeloma Support Group
Hamilton & District
Hamilton, Ontario, Canada


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Minutes - May 10, 2008

Saturday, May 10, 2008         

 

                        MULTIPLE MYELOMA SUPPORT MEETING

 

Lori announced an upcoming Conference presented by the Toronto and area MM Support Group.  The Patient, Family & Healthcare Professionals Conference will be held on September, 12 & 13, 2008; at the Toronto Marriott Airport Hotel.  Myeloma experts will include Joseph R. Mikhael, Nikhil C. Munshi, Donna E. Reece, David H. Vesole, and guest speakers will be Robert A. Buckman, Richard Beliveau, and Michael Katz.  The dates of this conference clash with our scheduled support meeting.  We have chosen to promote the meeting in Toronto as there will be very interesting and important information shared.  Lori will pass on any information as she receives it and will try to arrange car pooling where necessary.  Overnight stays are a possibility.  If you are interested in attending, please leave your name and number at the back. Please note that in supporting the Toronto meeting, our meeting will be canceled.

 

Lori and Marnie attended the MM Support Group Leader Retreat in Arizona.  Lori shared some information gained from this retreat.

Revlamid should be approved between the end of this summer and Christmas of this year.

If you already receive Revlamid free of charge, then you will continue to get it at no cost to you.  Groups will be advocating to get Revlamid covered.  There will be a fight to win coverage just as there was with Velcade. Both oral and IV uses should be covered when approval is obtained.

 

There will be an open meeting on May31, 2008 in Mississauga. Anyone interested in attending can see Steve.

 

Patients are living with Myeloma now, not necessarily dying from it.

 

There has been a tremendous amount of “high class” research in the last 5 to 6 months for Multiple Myeloma.

 

October is Multiple Myeloma Awareness Month

The group is looking into setting up a table at the Juravinski Cancer Center.  There are still people in the area who don’t know about our Support Group and are facing MM alone.

 

Lori introduced our guest speaker,  Dr. Ann Benger, a Clinician who sees patients with MM .

 

Topic: Multiple Myeloma - Where have we been?

                                             Where are we going?

 

1844    -first patient

            -Sarah Newbury - 39 year old woman

            -patient of Dr. Solly      

            -fractures - bone pain and fatigue

            -problems with urine and bone marrow

            -treatment - rhubarb pill with an infusion of orange peel

 

            -2nd patient  Thomas Alexander McBean

            -45 year old tradesman

            -severe chest pain and breast bone pain

            - unusual protein in urine

            - treatment - removal of one pound of blood

            -                 -maintained with leeches

            -later treatment - steel and quinine

 

1873    -Dr. Ruzitsy coined Multiple Myeloma

1895    -Dr. Waldenstrom - plasma cell       

1928    -recognition of protein in the blood

1929    -Dr. Arinkin developed bone marrow test

 

What is Multiple Myeloma?

Modern Day Definition - cancer of plasma cells

 

Consequences of Multiple Myeloma

 

- uncontrolled growth of one clone of plasma cells

- bones - OAF - dissolves surrounding bone

- causes lytic lesions and fractures

- calcium dissolves out of bone into blood stream

 

Bone Marrow - crowds out normal blood forming cells

                        - anemia

                        - low white count

                        - low platelets

 

Blood   - protein builds up

            - effects of high protein are many

            - more water comes in with blood, worsening anemia

            - blood cannot equalize

            - too thick and very hard to pump causing many side effects

            - easier to bleed

            - includes susceptibility to infections

            - protein levels are fairly good makers of how well treatment is working

 

Kidneys            - MM proteins can directly damage kidney cells and lead to Kidney failure  

                        - protein wasting conditions (Nephrotic Syndrome)

 

Treatment

 

1947    -Urethane

            -subsequent trial in 1966 comparing oral Urethane to cherry or cola-flavored

            syrup showed no improvement in symptoms or survival with Urethane

 

1958-1962

            - Melphalan

            -showed a definite response in 50 - 60% of patients

 

            -adding Prednisone improved response rates and increased survival compared to    

            Melphalan alone

 

1998    -review of many trials comparing newer combinations of drugs to

            Melphalan and Prednisone showed some increase in response rates

            -no improvement in overall survival

 

Autologous Stem Cell Transplant in Myeloma

 

            -1996   French Myeloma

            -Intergroup;  200 new patients with MM assigned treatment with conventional

            Chemotherapy or Chemotherapy with a Transplant

 

            -response rates were significantly better in the transplant group

 

            - overall, literature shows about a 12 month increase in survival or remission

 

Tandem Transplant

 

            -could repeating a transplant improve the outcome

            -patients who achieve complete or very good partials had longest survival

            -five trials - three report benefit

                             - two report no benefit

 

            -definitely no benefit to a second transplant

 

Allogeneic Transplant

 

            -transplant from a sibling - could this lead to a cure

            -results very disappointing

            -very few people were cured

            -too toxic

 

Newer Drugs

 

?? Smarter treatments instead of stronger drugs

 

Thalidomide

 

1957    -introduction by a German pharmaceutical company as a sedative

1960    -sold in more than 40 countries (not USA)

            -popular both as a sedative and as a treatment for morning sickness

1961    -first reports of fetal malformations

1997    -Dr. Barlogie noted that Thalidomide has anti-antigenic properties and wondered        

             that it might be helpful in patients with MM

            -trials in patients who have progressed after other treatments have shown 30%

             response rate (56% if Dexamethasone added)

            -first new drug active as a single agent

 

Bortezomib (Velcade)

 

2004    -”proteosome inhibitor”

            -leads to cell death

            -cancer cells and proliferating cells are more sensitive than normal

            -40% previous response rate

            -52% with Dexamethasone

            -lasts 12 months on average

            -funded and available (1 round only)

            -lots of side effects

 

Lenalidomide (Revlamid)

 

            -a newer, hopefully better from of Thalidomide

            -2 large trials in relapsed patients have shown better responses to Revlamid than

             to high dose of Dexamethasone alone

            -will likely be released within the next 6 - 12 months

            -cost??? - big challenge -  $72,000.00 per year

 

Combinations - Chemotherapy with Newer Agents

 

            -Dr. Palumbo - elderly patients, first line

           

            -randomized - M + P

                                    M + P + T

                                    VAD + Transplant

 

            -M+P+T had best response and survival

            -Thalidomide + Dexamethasone

            -Revlamid + Dexamethasone

            -Velcade + Liposomal Doxorubicin

            -Velcade + Dexamethasone

            -Melphalan + Prednisone + Revlamid

            -Melphalan + Prednisone + Velcade

 

Role of Maintenance Therapy

 

            -after Melphalan + Prednisone : Interferon

            -tried, but too many side effects with little improvements

            -after transplant : Thalidomide + Prednisone

            -possibly better than tandem transplant, but no studies as of yet

 

Supportive Care

 

            -Pamidronate - reduces bone pain and fractures

            -how long to continue?

            -generally two years

            -any longer could lead to Osteo-chronosis of the jaw

 

            -Kypho-plasty

            -on spine

            -inject a cement like substance

            -can have extreme side effects

 

Question and answer period.

 

Thanks and applause for Dr. Benger’s wonderful presentation.

 

 

Next Meeting - Saturday, July 12, 2008

Topic   - Community Support agencys