Hamilton Regional Multiple Myeloma Support Group
Hamilton, Ontario, Canada

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Hamilton Multiple Myeloma

Support Group Meeting

Saturday May 8th 2010


Canwell DVD was viewed while members got settled. Canwell is a program at the YMCA for cancer patients. Lori is a participant and appears throughout the video and Lori has copies for borrowing if anyone is interested.


The scheduled speaker for today had a personal emergency and was unable to attend. Our speaker will be Dr. Peter Anglin. He is the staff haematologist at Princess Margaret in Toronto. He will be addressing us via DVD.


Today's Outline

  • Review the development of new drugs for MM
  • Touch on some hi-lights of the American Society of Haematology meeting 2008
  • Put in perspective current treatment options available for MM
  • Discussion/questions


Multiple Myeloma is defined by the presence of end organ damage

  • Anemia
  • Body tensions
  • Hypercalcemia
  • Renal Insufficiency


The 2 clinical staging systems compared: Durie-Salmon vs ISS


A measurement of determining the detection of the illness would involve monitoring of Monoclonal Protein Serum Protein Electrophoresis. 


Definitions of Response

  • Complete Response (CR)
  • Stringent CR
  • Very Good Partial Remission (VGPR)
  • Partial Remission (PR)
  • Stable Disease (DS)
  • Progressive Disease (PD)


Multiple Myeloma is a chronic disease treated over several years with sequential therapies.


Milestones in Myeloma Therapy

  • MP 1960
  • Combinations 1980
  • ASCT 1990
  • Thalidomide, Lenalidomide, Bortezomib 2000-2005


There remain evolving treatment paradigms in the approach to Myeloma

  • Novel agents ---> Induction
  • Dose 2nd Transplant Timing ---> High Dose Therapy
  • Single, Combo ---> Maintenance
  • Novel agents ---> Relapsed Disease


There are many new drugs available to manage MM in the last few years

  • IMiDs ---> Thalidomide, Lenalidomide (Revlimid)
  • Proteosome inhibitors ---> Bortezomib (Velcade)
  • Pegylated Doxorubcin (Doxil)


These newer drugs work at many different levels ... not just at the tumour site.


There remain evolving treatment paradigms in the approach to Myeloma.


First-line treatment approaches

  • Conservative
    • Elderly (>age 70)
    • Poor Function
    • Conventional Therapy
  • Transplant

o       Young (<age 70)

o       Good Function

o       High-dose therapy with ASCT



Goals of Therapy - Induction and then ASCT

  • CR
  • VGPR


  • Need for 2nd transplant


  • Ramifications for ASCT progression free survival and overall survival


Current Approach to Induction Therapy for Transplant Eligible Patients

  • Dex alone
  • Dex + Thalidomide
  • Combinations exploring combinations of new agents


  -CyBorD regimen

  -RVDD regimen (current trial)


The question of more is better is not clear...

  • There is a belief that the more the myeloma clone is suppressed initially the better the outcome ...

-Longer life...

-Longer PFS

    - Time before myeloma begins acting up again



  • Novel agents incorporated into induction pre-ASCT improves CR/VGPR rates

-before and after ASCT

  • PFS benefit may be more with novel combo induction
  • Toxicity profiles appear acceptable


  • OS (overall survival) benefit and QOL data remain unclear


While there appeared to be a significant benefit in PFS for patients <VGPR, OS was not better.


There may be a role for a "consolidation effect" in patients who have a suboptimal response (<VGPR) to ASCT.


First-line therapy:

Non-transplant candidates


Conservative Therapy

  • Melphalan + prednisone
  • Cyloxan 500mg po weekly + prednisone 100mg po q 2 days


  • RR 50-50%, rare CR
  • Slow responses (4-6 mos)
  • Toxicities minimal


For non-transplant patients what is the best option for up-front therapy?


With traditional agents response duration lessens with each regimen.


Choice of therapy at relapse: Issues for consideration

  • Drug Characteristics
  • Patient Characteristics
  • Disease Characteristics


Newer generation novel agents are offering further treatment options.

  • Carfilzomib
  • Pomalidomide


Take-aways Today

  • There are many treatment options for MM
  • Not clear how important the order of drugs is
  • We are achieving much higher rates of CR and VGPR than before
  • Treatment priorities remain ---> length of life , quality of life
  • Transplant remains important for now but this may change ---> at least we may use it differently


The remainder of the DVD consisted of Questions and Discussion.


If anyone is interested in obtaining a copy of the DVD please contact Lori with your name.


Denise Stirling, Lori's sister, will be participating in the relay for life, there is a sponsor sheet available if anyone is interested.


The next meeting is Saturday, July 10th 2010. Scheduled speaker: Dr. Foley.