1. Myeloma hope new treatment in the horizon
Dr Amin Islam
MB, MRCP UK , FRCPath UK
Consultant haematologist and Haemato-Oncologist
Southend University Hospital NHS Foundation trust
Myeloma patients support group meeting
28th June 2016

2. myeloma Multiple myeloma (MM) is a mature B-cell neoplasm
accounts for 13% of all hematologic malignancies
an age-adjusted incidence rate of nearly 6 per 100 000 persons per year .
primarily affects older individuals with a median age at the time of diagnosis of nearly 70 years.

3. define
MM is defined by the presence of ≥10% of clonal plasma cells (PCs) in the bone marrow or a biopsy-proven extramedullary plasmacytoma)
Evidence of end-organ damage attributed to the PC disorder (hypercalcemia, renal insufficiency, anaemia, and bone lesions
If none above then it is smouldering/asymptomatic myeloma
Watch and wait strategy still valid with trial provisions

4. Pet scan

6. hope Over the past decade,
Median survival of myeloma patients has almost doubled
From 4 to 8 years

7. improvements
This remarkable improvement is mostly because of the use of high-dose therapy
Followed by autologous stem cell transplantation (ASCT)
Addition to the widespread incorporation of novel agents including immunomodulatary drugs
(IMiDs; (thalidomide and lenalidomide)
proteasome inhibitor (PI; bortezomib).

8. Newer drugs and more
The arsenal of effective novel agents for patients with relapsed disease is constantly increasing
Includes a next-generation IMiD (pomalidomide) –(not available in NHS anymore)
Next-generation PIs (carfilzomib, ixazomib, oprozomib, and marizomib),
Histone deacetylase inhibitor (panobinostat),
Monoclonal antibodies (directed against CD38: daratumumab, isatuximab [SAR650984], and MOR202; or against SLAMF7: elotuzumab).

9. Current standard Fit and good PS VAD/VTD total 4-6 course
Leading to ASCT
Non responder-option of clinical trials and next line
Relapsed setting:------
Revlimid and dexamethaone and try to ASCT
Ponabinostat/valcade and dexamethasone( available as second line therapy)

10. unfit
MPV
MPT
CTD a
VD etc

11. Supportive care Bone care 2 years of Bisphosphonate therapy Spine care
Infections
Role of orthopaedic interventions
Role of Radiotherapy

12. Clinical trials UK
Role of clinical trials
Newer drugs development

13. Myeloma 11
This trial has two treatment pathways; an intensive treatment pathway which includes high-dose therapy and stem cell transplantation for younger and/or fitter patients,
and a non-intensive pathway for older and/or less fit patients. The trial is looking at the effects of lenalidomide, bortezomib and carfilzomib for newly diagnosed myeloma patients as induction, consolidation and maintenance treatments involving:
Lenalidomide, cyclophosphamide and dexamethasone (CRD) as induction/initial treatment
Lenalidomide, cyclophosphamide, carfilzomib and dexamethasone (CCRD) as induction/initial treatment
Bortezomib, cyclophosphamide and dexamethasone (CVD) as consolidation treatment for patients who do not respond well to their induction/initial treatment
Lenalidomide as maintenance treatment to control the myeloma further

14. Daratumumab, Revlimid and dexamethasone for newly diagnosed myeloma patients
Treatments:
Daratumumab Lenalidomide (Revlimid) Dexamethasone
Myeloma stage:
Newly Diagnosed
Trial phase:
III
Summary:
This trial is determining whether daratumumab in combination with lenalidomide (Revlimid) and dexamethasone is more effective than Revlimid and dexamethasome alone in newly diagnosed myeloma patients who are not eligible for high-dose therapy and stem cell transplantation.

15. Carfilzomib for newly diagnosed patients prior to stem cell transplant (CARDAMON trial)
Summary:
This trial is for younger and/or fitter newly diagnosed myeloma patients. It is determining whether patients should be given high-dose therapy and a stem cell transplant straight after their induction treatment, or if they have responded well, whether it is better to delay the high-dose therapy and stem cell transplantation until relapse.
All patients in this trial receive carfilzomib maintenance treatment.
This is also known as the CARDAMON trial.

16. Daratumomab in smouldering myeloma List goes on…..
There are many more
Daratumomab in smouldering myeloma
List goes on…..
Hope of cure not far from reality……..

17. Palliative care options Macmillan support and grants
myeloma
Lets talk
Support groups
Palliative care options
Macmillan support and grants