The Friday before the official start of ASH is always considered Symposium day. Symposiums typically last a couple of hours and involve several myeloma expert doctors discussing patient cases and various treatment options. Patient cases can vary from smoldering to newly diagnosed to early and late relapse along with the consideration of risk factors and comorbidities.

These meetings are sponsored by advocacy organizations such as the International Myeloma Foundation, Healthtree Foundation, and Research-to-Practice as well as pharma companies. While they don’t include new information that will subsequently presented at ASH, they provide treatment suggestions currently approved by the FDA as well as consideration of ongoing clinical trials.

As such, my particular goal is to listen for insights provided by the specialists and offer those takeaways in this blog. After attending three symposiums, here’s what I heard:

  1. Dr. Nikhil Munshi: “Despite progress with newer therapies, challenges remain in delivering effective treatment to MM patients.”
  2. Dr. Jesus San Miguel: “There’s more to determining high-risk smoldering multiple myeloma (HRSMM) than the 2-20-20 formula, such as speed of disease progression, cytogenetics, and more.”
  3. Dr. S. Vincent Rajkumar: “Treatment for HRSMM should be either Rev/Rev-dex or a clinical trial.”
  4. Dr. Shaji Kumar: “At Mayo Clinic, we use four-drug induction therapy for HRMM but will wait for more evidence before using four drugs for standard-risk multiple myeloma.” Contrary to that guideline, Dr. Tom Martin: “At UCSF, we use four drugs for everyone.”
  5. Dr. Philippe Moreau: “Perhaps we should be using two drugs (Dara-Rev) for maintenance of HRMM patients.”
  6. Dr. S. Vincent Rajkumar: “Relapse within 12 months of a stem cell transplant should be considered “High Risk” even if cytogenetics didn’t show these mutations.
  7. Dr. Tom Martin: “We lose between 15-35% of patients at the next relapse so we always want to give the best treatment next rather than saving it.”
  8. Dr. S. Vincent Rajkumar: “Use the TRAP algorithm when making subsequent treatment decisions. T=Timing of relapse; R=Response from prior therapy; A=Aggressiveness of disease; and P=Performance status.
  9. Dr. Yi Lin: “Teclistamab typically requires an initial minimum 7-day hospital stay, requiring 3 step-up doses, 48 hours in between each. However, if an out-patient clinic (such as at Mayo) has immediate access to hospital treatment, a patient may be treated as an out-patient.”

I listened to several talks on Decentralizing Clinical Trials. Rebekah Angrove, PhD, stated: “The number one reason for patients not participating in clinical trials is because they were never asked.” That’s a lesson to us patients that we should ask our oncologist if there’s a clinical trial we should consider.

Dr. Noopur Raje: “If the financial impact is similar, our facility prefers using denosumab over Zometa since myeloma patients are prone to kidney disease.”

Dr. Jesus Berdeja: In very early analysis, sequencing BCMA therapy (Blenrep, bispecifics) followed by a BCMA CAR-T appears to show less effective CAR-T results, whereas the reverse appears not to be true.”

That’s it for tonight. My first meeting tomorrow International Myeloma Working Group (IMWG) is at 4:30 a.m. PST, so it’s early to bed for tomorrow’s official Day 1 of ASH!

Be your own best patient advocate.
— Jack Aiello, on Twitter @JackMAiello