The very first session I attended at this year’s American Society of Hematology (ASH) Annual Meeting was a Friday Satellite Symposium sponsored by Clinical Care Options and the International Myeloma Foundation. The symposium title, “A Conversation with the Myeloma Experts: Making Sense of the Evolving Treatment Landscape,” perfectly captured everything that was so incredible about this symposium, and it framed how I’ve continued to think about the following sessions I have attended at ASH over the past two days.

Truly, this symposium was a panel of MYELOMA EXPERTS, and in just one session these experts provided a comprehensive overview of the current guideline recommendations for treating myeloma at all stages of the disease. Jesus San-Miguel, MD, PhD, discussed determining risk for progression for smoldering multiple myeloma and when to initiate treatment. Philippe Moreau, MD, discussed optimal induction therapy for newly diagnosed multiple myeloma patients and how long to continue maintenance on this first line. S. Vincent Rajkumar, MD, discussed when to start a new line of therapy at signs of first relapse, and Thomas G. Martin, MD, discussed optimal therapies for first relapse. Shaji J. Kumar, MD, discussed selecting the next therapy for patients who have experienced multiple relapses, and then Tom Martin, MD, addressed patient and disease factors that would change the treatment approach. Finally, Yi Lin, MD, PhD, discussed treatment options for patients who had already received a BCMA-targeted therapy.

This symposium was indeed a CONVERSATION, not just among the panelists but also with the audience, highlighting the patient-focused nature of treatment decisions, in a time where there are so many new therapeutic options for treating multiple myeloma. The majority of the audience members were physicians, and they were split between those who worked at a large academic center and those who worked at a smaller hospital. There were also other health care workers, researchers, and patient advocates among the audience members. In addition to answering audience questions after their talks, the panelists engaged the audience by presenting a case study and first polling the audience about how they would treat the myeloma patient before presenting their talk. Then they repolled the audience to see if their treatment decision had changed. The audience also got to see how the expert panelists answered the question, and they didn’t always agree, which emphasized the importance of patient-driven treatment decisions. I was excited to see that I have learned a lot after 5-1/2 years with myeloma and 2-1/2 years leading a myeloma support group, as my answers to the polling questions matched those of the experts.

When considering all of these talks in combination, the symposium provided a comprehensive view of the evolving treatment LANDSCAPE for multiple myeloma. I love this concept of a landscape, and it’s one that I’ve used often in the past to describe the big picture of my own scientific professional work. I’ve spent my career studying the process of how a protein folds into its proper shape for biological function and how protein misfolding can lead to disease. I’ve often used landscape figures, which look like upside-down mountain ranges in my case, to summarize my scientific findings. I was so excited to see Dr. Tom Martin, MD using landscape figures to describe the big picture view of myeloma treatment from early to late-stage disease. In his case, the mountain peaks are times of disease burden and the valleys between the mountains are times when myeloma is well controlled. It was interesting to learn that the treatment goal is to reach sustained minimal residual disease (MRD)-negativity in each valley so that patients can have a time off-treatment to give their bodies and immune systems a chance to recover before the next treatment line is needed. I’m currently on my second line of therapy after my first relapse, and my most recent bone marrow biopsy results show that I’ve reached MRD-negativity. It would be great if I could maintain MRD-negativity for another year and get a treatment holiday, as I’m always battling neutropenia with treatment that impacts my quality of life.

When I think about the evolving treatment landscape for myeloma patients, I can’t help but be optimistic. My sons love to hike, and they have hiked across mountain ranges in both the western and eastern United States, always commenting on the majestic and perspective-changing view. Sometimes, as a myeloma patient, I know that I can get so focused on climbing the daily mountain of my disease, that I lose track of the big picture and forget to celebrate how far I’ve come. After ASH is over, I’m planning to hike the mountain near my home and take a moment to enjoy the view of the local landscape and count my blessings. I am so grateful for all of the amazing myeloma experts (physicians and researchers) who have made so much progress in the myeloma treatment landscape and provided so much hope and promise for patients!

Jill Zitzewitz, PhD
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