Disclosures for Alessandra Larocca, MD
|
|
- Prosper Shepherd
- 5 years ago
- Views:
Transcription
1 Disclosures for Alessandra Larocca, MD Research Support/P.I. Employee Consultant Major Stockholder Speakers Bureau Honoraria No relevant conflicts of interest to declare No relevant conflicts of interest to declare No relevant conflicts of interest to declare No relevant conflicts of interest to declare No relevant conflicts of interest to declare Celgene, Janssen-Cilag, BMS, Amgen Scientific Advisory Board No relevant conflicts of interest to declare Presentation includes discussion of the off-label use of a drug or drugs
2 Multiple Myeloma 2017 Highlights A post International Myeloma Workshop (IMW) Summary Paris, France April 21-22, 2017 Geriatric evaluation Alessandra Larocca, MD, PhD Division of Hematology University of Torino Torino, Italy
3 Myeloma is a disease of the elderly Incidence according to age In UK median age at diagnosis 73 (1990s) Latest USA SEER registry data: 55% are 75 years of age ( ) 70% 43%
4 10-Year relative survival (%) Introduction of novel agents has improved overall survival in MM < Calendar period The major benefit was observed in younger patients Brenner H, et al. Blood. 2008;111:
5 Age negatively affects survival In MM patients Meta-analysis of 1435 newly diagnosed MM patients treated with MP, MPT, VMP, VTP or VMPT-VT Age 3 year OS < 75 years 68% > 75 years 57% Bringhen S, et al. Haematologica 2013; 98 (6):
6 Grade 3/4 cardiac infective, GI AEs impact on survival of 1435 myeloma patients *At least one adverse event; Due to AEs, withdrawal of consent, patient compliance, unknown; progressive disease was excluded AE, adverse event; GI, gastrointestinal Bringhen S, et al. Haematologica. 2013;98: ; Larocca A, et al. Blood 2013;122: Abstract 687 and oral presentation at ASH 2013
7 CLARION STUDY Study Design Transplantineligible NDMM Randomization 1:1 N = 955 Stratification: ISS stage Route of bortezomib administration (if randomized to VMP) Region Age Maximum 9 cycles KMP Carfilzomib a 36 mg/m 2 IV Days 1, 2, 8, 9, 22, 23, 29, 30 (20 mg/m 2 days 1, 2, cycle 1 only) IV over 30 minutes Melphalan b 9 mg/m 2 and Prednisone 60 mg/m 2 Days 1 4 Maximum 9 cycles VMP Bortezomib 1.3 mg/m 2 Days 1, 4, 8, 11, 22, 25, 29, 32 (Days 4, 11, 25, 32 omitted for cycles 5+) IV or SC Melphalan b 9 mg/m 2 and Prednisone 60 mg/m 2 Days 1 4 Primary endpoint: PFS Secondary endpoints: OS, CRR, ORR, grade 2 PN rate, HRQoL, safety and tolerability Exploratory endpoint: MRD a Carfilzomib was administered for 2 weeks out of 3 twice per cycle b Melphalan dose was 7 mg/m 2 if age was > 75 years or CrCl was 30 to < 50 ml/min; 5 mg/m 2 if CrCl was 15 to < 30 ml/min. 1 CRR, complete response rate; CrCl, creatinine clearance; HRQoL, health-related quality of life; ISS, International Staging System; IV, intravenous; KMP, carfilzomib, melphalan, prednisone; MRD, minimal residual disease; ORR, overall response rate; OS, overall survival; PD, progressive disease; PFS, progression-free survival; PN, peripheral neuropathy; SC, subcutaneous; VMP, bortezomib, melphalan, prednisone Facon T, et al. Presented at: 16th International Myeloma Workshop; New Delhi, India; March 1-4, 2017.
8 Proportion Event-Free CLARION STUDY Primary Endpoint: Progression-Free Survival Number at risk: Median follow-up time: 22.2 months for KMP and 21.6 months for VMP The absence of PFS difference was consistent across subgroups 0 KMP VMP KMP (n = 478) Months VMP (n = 477) Disease progression or death, n (%) 207 (43.3) 214 (44.9) Median PFS, months HR for KMP vs VMP (95% CI) 0.91 ( ) 1-sided P value 0.16 KMP VMP CI, confidence interval; HR, hazard ratio; KMP, carfilzomib, melphalan, prednisone; PFS, progression-free survival; VMP, bortezomib, melphalan, prednisone 0 0 Facon T, et al. Presented at: 16th International Myeloma Workshop; New Delhi, India; March 1-4, 2017.
9 Proportion Without PD CLARION STUDY Time to Progression Number at risk: 0 KMP VMP KMP (n = 478) VMP (n = 477) Disease progression, n (%) 162 (33.9) 185 (38.8) Median TTP, months HR for KMP vs VMP (95% CI) 0.84 ( ) Nominal 1-sided P value Months KMP VMP CI, confidence interval; HR, hazard ratio; KMP, carfilzomib, melphalan, prednisone; PD, progressive disease; TTP, time to progression; VMP, bortezomib, melphalan, prednisone Facon T, et al. Presented at: 16th International Myeloma Workshop; New Delhi, India; March 1-4, 2017.
10 CLARION STUDY AEs of Interest AE, % KMP (n = 474) VMP (n = 470) All Grade Grade 3 All Grade Grade 3 Acute renal failure a Cardiac failure a Ischemic heart disease a Hypertension a Dyspnea b Grade 5 AE Leading to treatment discontinuation a Standardized MedDRA Queries Narrow Search. b High-level term. AE, adverse event; KMP, carfilzomib, melphalan, prednisone; MedDRA, Medical Dictionary for Regulatory Activities; VMP, bortezomib, melphalan, prednisone Facon T, et al. Presented at: 16th International Myeloma Workshop; New Delhi, India; March 1-4, 2017.
11 All elderly are not equal Fit and Frail
12 Treatment goals in elderly MM patients FIT INTERMEDIATE FRAIL Co-morbidities, organ disfunction Life expectancy Impaired functional status Deep remission Balance efficacy/safety Do not harm Goal CR/MRD-negativity Good response QoL Priority Efficacy Combination of efficacy/safety Low toxicity
13 How to assess frailty? How to identify frail patients?
14 Geriatric Assessment (GA) ADVANTAGES LIMITATIONS Medical, psychosocial and Not routinely performed in functional capabilities hematology because it is complex and time-consuming. Impairment not identified in routine practice Multidimensional diagnostic process Predict severe treatment-related toxicity Predict OS in a variety of tumors Influence treatment choice and intensity The optimal tools for an appropriate GA need to be established. Wildiers H, et al. J Clin Oncol 2014: 32 (24):
15 GA or clinical judgement? GERIATRIC ASSESSMENT - age 80 years - ADL - comorbidity (CIRS-G) - geriatric syndromes Curative therapy GA 84 patients DLBC NHL Clinical judgement (blind to the result of GA) Palliative therapy 42 FIT patients by CGA received curative treatment by clinical judgment. 42 UNFIT patients by CGA: 20 received curative and 22 palliative therapy. UNFIT patients had similar outcome irrespectively of type of treatment. GA was an efficient method to identify elderly NHL patients who can benefit from a curative approach. Tucci A et al, Cancer 2009;115:
16 GA or Performance Status (PS)? 363 elderly patients with solid or hematologic tumors (age 72 ys) Among patients with a good PS 13.0% had 2 or more comorbidities 9.3% and 37.7% had ADL or IADL limitation Association between PS, number of comorbidities, and CGA GA Performance Status Repetto L. et al, J Clin Oncol 2002
17 GA in older patients with cancer detect unknown geriatric problems All patients G8 screening CGA 71% Presence of geriatric profile 1967 cancer patients 67% Unknown geriatric problems* 29% Absence of geriatric profile FIT * Geriatric problems related mainly to: functional status, nutritional status, fatigue Kenis et al. Ann Oncol 2013;24(5):
18 39 factors 13 factors 3 factors Frailty Assessment in Myeloma IMWG Frailty Score 1 Revised Myeloma Co-morbidity Index 2 Mayo Frailty System 3 N (172 no ASCT) Median Age 74 (46% 75) 63 (13% 75) 65 (33% 75) Population 6 study regimens Variable Len-based 63% BTZ-based 22% ASCT 39% Factors Access Age ADL IADL CCI tor.net/ Renal (Calc GFR) Lung (PFTs) KPS Fragility Age Cytogenetics rg Age 70 ECOG PS 2 NT-ProBNP 300 ng/l 1 Palumbo et al, Blood 2015; 2 Engelhardt et al. Haematologica 2017; 3 Milani et al. Am J Hematol 2016
19 IMWG Frailty Score Study design 2 phase III and 1 phase II EMN trials for NDMM patients, ineligible for autologous stem cell transplantation EMN01- NCT N=659 Rd vs MPR vs CPR MMY2069 NCT N=152 VP vs VMP vs VCP Katz s Activity of Daily Living (ADL) Lawton s Instrumental Activity of Daily Living (IADL) Charlson Comorbidity Index (CCI) IST-CAR-506 NCT N=58 Carfilzomib-Cyclo-Dex 869 analyzed patients Palumbo A et al, Blood 25(13): , 2015
20 Charlson index Geriatric Assessment Total points 0-37 Charlson M, et al. J Chronic Dis. 1987;40(5): Instrumental activity of daily living (IADL) Activity of daily living (ADL) The maximum total score is 6; ; 0=completely dependent. Katz S, et al. JAMA 1963;185: The maximum total score is 8; 0=completely dependent. Lawton MP, et al. Gerontologist 1969;9:
21 IMWG Frailty Score Variable HR (CI 95%) P SCORE AGE Age <75 years 1-0 Age years 1.13 ( ) Age >80 years 2.40 ( ) < CHARLSON INDEX Charlson <1 1-0 Charlson > ( ) ADL SCORE ADL >4 1-0 ADL< ( ) IADL SCORE IADL >5 1-0 IADL< ( ) ADDITIVE TOTAL SCORE PATIENT STATUS 0 FIT 1 INTERMEDIATE >2 FRAIL Palumbo A et al, Blood 25(13): , 2015
22 1.00 IMWG Frailty Score: long-term outcome Overall Survival Progression-free Survival yrs P-value Fit 84% - Intermediate 76% Frail 57% < Months Cumulative Incidence Non-hematologic mo P-value Fit 22% - Intermediate 26% Frail 34% < yrs P-value Fit 48% - Intermediate 41% Frail 33% < Months Cumulative Incidence Drug mo P-value Fit 16% - Intermediate 21% Frail 31% < Months Months Palumbo A et al, Blood 25(13): , 2015
23 Geriatric evaluation to select appropriate therapy in MM patients? Old chemotherapy (Melphalan) or Novel Drugs? Doublets or Triplets? ASCT? Continuous treatment? Newer drugs?
24 Geriatric evaluation to select appropriate therapy in MM patients? Old chemotherapy (Melphalan) or Novel No evidence based medicine in frail Drugs? patients: Doublets or Triplets? No randomized phase 3 trials ASCT? No randomized phase 2 trials Continuous treatment? No meta-analysis
25 Proportion of patients Proportion of patients Melphalan or New Drugs? Doublets or Triplets? PFS VD (N=168, 51% PFS events) VTD (N=167, 42% PFS events) VMP (N=167, 49% PFS events) OS VD (N=168, 27% OS events) VTD (N=167, 27% OS events) VMP (N=167, 25% OS events) 483 patients enrolled 50% patients with 1 co-morbidity 42% >75 years and 18% >80 years Median PFS 14.7, 15.4, and 17.3 months Time (months) Median OS 49.8, 51.5, and 53.1 months Time (months) VD, bortezomib-dexamethasone; VMP, V melphalan-prednisone; VTD, VD thalidomide Niesvizky R, et al. JCO 2015
26 CPR vs MPR vs Rd Melphalan or Novel Drugs? Progression-free survival Rd vs MPR: HR 1.189; CI ; p=0.20 Rd vs CPR: HR 1.032; CI ; p=0.81 Doublets Median follow-up or Triplets? 26 months Median PFS CPR 24 months MPR 27 months Rd 22 months Overall survival 2-year OS CPR 84% MPR 81% Rd 80% Rd vs MPR: HR 0.954; CI ; p=0.82 Rd vs CPR: HR 1.033; CI p=0.88 ; months months R, Lenalidomide; d, low dose dexamethasone; C, cyclophosphamide; M, melphalan; P, prednisone; PFS, progression-free survival; OS, overall survival; PFS, progression-free survival. Magarotto V, et al. Blood 2016
27 PAD ASCT? Phase 2 GIMEMA TRIAL 102 newly diagnosed myeloma patients Age years or inelegible for Melphalan 200 mg/sqm PAD-MEL100-LP-L PBSC Mobilization (Cyclophosphamide+G-CSF) MEL-100 ASCT 4 cycles 2 cycles 2 cycles LP 4 cycles PAD = Bortezomib+Pegylated Doxorubicin+Dexamethasone; MEL100 = Melphalan100 mg/m2; LP = Lenalidomide + Prednisone; L= Lenalidomide L Gay F et al. Blood 2013;122:
28 TTP Median 55 months 5-year 43% ASCT? PAD-MEL100-LP-L: Survival Median follow-up: 66 months PFS OS Median 48 months 5-year 43% Median not reached 5-year 63% TTP:time to progression, PFS: progression-free survival, OS: overall survival Gay F et al. Blood 2013;122:
29 ASCT? Discontinuation or Deaths related to AEs Discontinuation or death related to AEs All patients (N=102) Patients <70 years (N=76) Patients >70 years (N=26) 30 (29%) 20 (26%) 10 (38%) AEs 22 (22%) 17 (22%) 5 (19%) Deaths 8 (8%) 3 (5%)* 5 (19%)* P value (Fisher exact test) In pts >70 years during induction and transplant: Higher rate of infections (34% vs 21%) Higher treatment related deaths AEs: Adverce events, N: number Gay F et al. Blood 2013;122:
30 Patients alive and progression-free (%) No. of patients at risk: Lenalidomide Observation CONTINUOUS TREATMENT? Myeloma XI study: Lenalidomide maintenance Transplant non-eligible Significant improvement in PFS from 11 to 24 months, HR= Time since randomisation (months) Median PFS, months [95% CI] Lenalidomide (n=406) 24 [21, 30] Observation (n=317) 11 [9, 13] HR=0.42; 95% CI 0.35, 0.51 Log-rank p< Jackson GH et al ASH 2016 Courtesy by Prof Gareth J. Morgan
31 CONTINUOUS TREATMENT? FIRST trial: Frailty Analysis Progression-free survival HR, hazard ratio; MPT, melphalan, prednisone, and thalidomide; NR, not reached; PFS, progression-free survival; pt, patient; Rd, lenalidomide and low-dose dexamethasone; Tx, treatment. Facon T. A Frailty Scale Predicts Outcomes in Patients With Newly Diagnosed Multiple Myeloma Who Are Ineligible for Transplant Treated With Continuous Lenalidomide Plus Low-Dose Dexamethasone in the FIRST Trial. ASH 2015, abstract 4239 Facon T, et al. Abstract 4239, ASH 2015
32 RANDOMIZATION 1:1 A phase III, multicentre, randomized study to determine the efficacy and safety of standard schedule versus a new algorithim of dose reductions in ELDERLY INTERMEDIATE newly diagnosed myeloma patients Event-free survival* PD, OS and Subsequent anti-mm Tx Screening Arm A Continuous Rd Arm B Rd9-R Active Treatment + PFS Follow-up Phase LEN + Lo-DEX: 9 Cycles LENALIDOMIDE 25mg D1-21/28 Lo-DEX 20mg D1,8,15 & 22/28 LEN + Lo-DEX Continuously LENALIDOMIDE 25mg D1-21/28 Lo-DEX 20mg D1,8,15 & 22/28 Lo-LEN Continuously Lo-LEN 10mg D1-21/28 *Event-free survival defined as: Progression Death for any cause Discontinuation of lenalidomide therapy Occurrence of any haematological grade 4 or non-haematological grade 3-4 adverse events (AES), including Secondary Primary Malignancies (SPMs) LT Follow-Up LT, long-term; PD, progressive disease; OS, overall survival
33 NEWER DRUGS? Summary of key studies in RRMM Progression-free survival by Age ELOQUENT-2: ERd vs Rd ASPIRE: KRd vs Rd POLLUX: DRd vs Rd TOURMALINE-MM1: IRd vs Rd Stewart K, NEJM Lonial S NEJM Moreau P, NEJM 2016, Dimopoulus et al. EHA 2016
34 Conclusions 34
35 1. Treatment goals based on frailty Life expectancy PATIENT STATUS ASSESSMENT Age (score 0 1 2) Charlson (score 0 1) ADL (score 0 1) IADL (score 0 1) FIT INTERMEDIATE FRAIL Co-morbidities, organ function Impaired functional status Deep remission Balance efficacy/safety Do not harm Goal CR/MRD-negativity Good response QoL Priority Efficacy Combination of efficacy/safety Low toxicity
36 2. Treatment algorithm based on balancing safety and efficacy PATIENT STATUS ASSESSMENT Age (score 0 1 2) Charlson (score 0 1) ADL (score 0 1) IADL (score 0 1) FIT INTERMEDIATE FRAIL Additive total score = 0 Additive total score = 1 Additive total score 2 Full-dose Full-dose/Reduced Reduced dose TRIPLET REGIMENS DOUBLET REGIMENS Doublet regimens VMP Rd -> R? rd MPT Vd Vd Rd Palliative VRD ASCT Palumbo A et al, Blood 25(13): , 2015
37 Patients ADL IADL 3. Treatment Decision Process Comorbidities Hospitalization Medications Social Support Goals of Care CR vs Disease Control Expectations Multiple Myeloma Cytogenetics Stage Tumor burden Newer Drugs Comorbidities: cardiovascular Karf! pulmonary functions MoAb! Compliance +Ixazomib Toxicities Neuropathy + Karf DVT/PE +MoAb Cardiac toxicity +MoAb
38 Conclusion Elderly patients live on the borderline of a precariously balanced physiological state. It is more important to know what sort of person has a disease than to know what sort of disease a person has [Hippocrates]
39 Acknowledgments Divisione di Ematologia U Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino Prof. Mario Boccadoro Dr. Sara Bringhen Dr. Francesca Gay Dr. Chiara Cerrato Dr. Mariella Genuardi Dr. Roberto Mina Dr. Stefania Oliva Dr. Mattia D Agostino Dr. Marco Salvini Dr. Giusy Cetani Dr. Paola Omedé & Laboratory Staff Dr. Benedetto Bruno & Transplant Unit Nurses Data Managing Staff Dr. Gianni Ciccone and CPO
Risk stratification in the older patient; what are our priorities?
Risk stratification in the older patient; what are our priorities? Sonja Zweegman MD PhD Amsterdam The Netherlands Negative impact of age on survival Meta-analysis of European trials (MP vs MPT, VMP vs
More informationCOMy Congress The case for IMids. Xavier Leleu. Hôpital la Milétrie, PRC, CHU, Poitiers, France
Xavier Leleu Hôpital la Milétrie, PRC, CHU, Poitiers, France The case for IMids COMy Congress 21 Disclosures Grants/research support: Amgen, Bristol-Myers Squibb, Celgene, Janssen, Millennium/Takeda, Novartis,
More informationTreatment Strategies for Transplant-ineligible NDMM Patients
1 Treatment Strategies for Transplant-ineligible NDMM Patients Thierry Facon, MD Professor of Hematology Service des Maladies du Sang University of Lille Lille, France Multiple Myeloma affects primarily
More informationTREATMENT FOR NON-TRANSPLANT ELIGIBLE MULTIPLE MYELOMA
TREATMENT FOR NON-TRANSPLANT ELIGIBLE MULTIPLE MYELOMA Ekarat Rattarittamrong, MD Division of Hematology Department of Internal Medicine Faculty of Medicine Chiang Mai University OUTLINE Overview of treatment
More informationDisclosures for Palumbo Antonio, MD
Disclosures for Palumbo Antonio, MD Research Support/P.I. Employee Consultant Major Stockholder Speakers Bureau Honoraria Scientific Advisory Board o relevant conflicts of interest to declare o relevant
More informationStandard of care for patients with newly diagnosed multiple myeloma who are not eligible for a transplant
Standard of care for patients with newly diagnosed multiple myeloma who are not eligible for a transplant Pr Philippe Moreau University Hospital, Nantes, France MP: Standard of care until 2007 J Clin Oncol
More informationTo Maintain or Not to Maintain? Immunomodulators vs PIs Yes: Proteasome Inhibitors
To Maintain or Not to Maintain? Immunomodulators vs PIs Yes: Proteasome Inhibitors James Berenson, MD Institute for Myeloma and Bone Cancer Research West Hollywood, CA Financial Disclosures Takeda, Celgene
More informationTreatment of elderly multiple myeloma patients
SAMO Interdisciplinary Workshop on Myeloma March 30 th -31 st 2012, Seehotel Hermitage, Lucerne Treatment of elderly multiple myeloma patients Federica Cavallo, MD, PhD Federica Cavallo, MD, PhD Division
More informationUpdate on Multiple Myeloma Treatment
Update on Multiple Myeloma Treatment Professor Chng Wee Joo Director National University Cancer Institute of Singapore (NCIS) National University Health System (NUHS) Deputy Director Cancer Science Institute,
More informationTreatment of elderly patients with multiple myeloma
Treatment of elderly patients with multiple myeloma Mario Boccadoro DIVISIONE UNIVERSITARIA DI EMATOLOGIA AZIENDA OSPEDALIERA SAN GIOVANNI TORINO, ITALY Improved survival in multiple myeloma and the impact
More informationInitial Therapy For Transplant-Eligible Patients With Multiple Myeloma. Michele Cavo, MD University of Bologna Bologna, Italy
Initial Therapy For Transplant-Eligible Patients With Multiple Myeloma Michele Cavo, MD University of Bologna Bologna, Italy Treatment Paradigm for Autotransplant-Eligible Patients With Multiple Myeloma
More informationIn-depth look at specific data-sets; which ones meet requirements? Individual data owners /cooperative groups
In-depth look at specific data-sets; which ones meet requirements? Individual data owners /cooperative groups Minimal Residual Disease (MRD) by Multiparameter Flow Cytometry (MFC) in transplant eligible
More informationRole of consolidation therapy in Multiple Myeloma. Pieter Sonneveld. Erasmus MC Cancer Institute Rotterdam The Netherlands
Role of consolidation therapy in Multiple Myeloma Pieter Sonneveld Erasmus MC Cancer Institute Rotterdam The Netherlands Disclosures Research support : Amgen, Celgene, Janssen, Karyopharm Advisory Boards/Honoraria:
More informationCREDIT DESIGNATION STATEMENT
CME Information LEARNING OBJECTIVES Integrate emerging research information on the use of proteasome inhibitors and immunomodulatory agents to individualize induction treatment recommendations and maintenance
More informationHighlights from EHA Mieloma Multiplo
Highlights from EHA Mieloma Multiplo Michele Cavo Istituto di Ematologia L. e A. Seràgnoli Alma Mater Studiorum Università degli studi di Bologna Firenze, 22-23 Settembre 27 Myeloma XI TE pathway 7 R :
More informationMultiple Myeloma: Approach to the Elderly
Multiple Myeloma: Approach to the Elderly Peter Anglin MD, FRCPC, MBA Stronach Regional Cancer Centre Newmarket, ON PMH Myeloma Day May 12, 2017 Peter Anglin MD Disclosures Speakers Bureau Advisory Boards
More informationCME Information LEARNING OBJECTIVES
CME Information LEARNING OBJECTIVES Identify patients with MM who have undergone autologous stem cell transplant and would benefit from maintenance lenalidomide. Counsel older patients (age 65 or older)
More informationComorbidities in Multiple Myeloma
Comorbidities in Multiple Myeloma Michel Delforge, MD, PhD University Hospital Leuven Leuven, Belgium COMy, Bangkok 12 may 2014 Comy Meeting, Bangkok, 12 may 2014 Disclosures Advisory board: Janssen,
More informationUnmet Medical Needs and Latest Multiple Myeloma Treatment
Unmet Medical Needs and Latest Multiple Myeloma Treatment Professor Chng Wee Joo Director National University Cancer Institute of Singapore (NCIS) National University Health System (NUHS) Deputy Director
More informationChristine Chen Princess Margaret Cancer Centre September 2013
Christine Chen Princess Margaret Cancer Centre September 2013 Disclosures Research Support Celgene, Janssen, GSK Employee N/A Consultant N/A Major Stockholder Speakers Bureau/ Scientific Advisory Board
More informationManagement of Multiple
Management of Multiple Myeloma in the Elderly Xavier Leleu Service des Maladies du Sang Hôpital Huriez, CHRU, Lille, France INSERM U837, équipe 3 IRCL, CHRU, Lille, France IMPRT Institut de Médecine Prédictive
More informationApproach to the Treatment of Newly Diagnosed Multiple Myeloma. S. Vincent Rajkumar Professor of Medicine Mayo Clinic
Approach to the Treatment of Newly Diagnosed Multiple Myeloma S. Vincent Rajkumar Professor of Medicine Mayo Clinic Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida Mayo Clinic College of
More informationContinuous Therapy as a Standard of Care CON. JL Harousseau Institut de Cancérologie de l Ouest Nantes Saint Herblain France
Continuous Therapy as a Standard of Care CON JL Harousseau Institut de Cancérologie de l Ouest Nantes Saint Herblain France 1 In France and in the IFM all debates 2 In France and in the IFM all debates
More informationNovel Combination Therapies for Untreated Multiple Myeloma
Novel Combination Therapies for Untreated Multiple Myeloma Andrzej J. Jakubowiak, MD, PhD Director, Myeloma Program New York, NY, October 27, 201 Disclosures 2 Employee Consultant Major Stockholder Speakers
More informationConsolidation and maintenance therapy for transplant eligible myeloma patients
Consolidation and maintenance therapy for transplant eligible myeloma patients Teeraya Puavilai, M.D. Division of Hematology, Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University
More informationCuring Myeloma So Close and Yet So Far! Luciano J. Costa, MD, PhD Associate Professor of Medicine University of Alabama at Birmingham
Curing Myeloma So Close and Yet So Far! Luciano J. Costa, MD, PhD Associate Professor of Medicine University of Alabama at Birmingham What is cure after all? Getting rid of it? Stopping treatment without
More informationUpfront Therapy for Myeloma Tailoring Therapy across the Disease Spectrum
Upfront Therapy for Myeloma Tailoring Therapy across the Disease Spectrum S. Vincent Rajkumar Professor of Medicine Mayo Clinic Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida Mayo Clinic
More informationManaging Newly Diagnosed Multiple Myeloma
Managing Newly Diagnosed Multiple Myeloma 26 Jan 2018 Alfred Garfall, MD Assistant Professor of Medicine Diagnosis of Multiple Myeloma Traditional criteria: Monoclonal plasma cells + attributable CRAB
More informationProgress in Multiple Myeloma
Progress in Multiple Myeloma Sundar Jagannath, MD Professor, New York Medical College Adjunct Professor, New York University St. Vincent s Comprehensive Cancer Center, NY Faculty Disclosure Advisory Board:
More informationConsolidation and Maintenance therapy
University of Salamanca Consolidation and Maintenance therapy María-Victoria Mateos, MD, PhD University Hospital of Salamanca, Spain Disclosure form MVM has served as member of advisory boards or received
More informationMyeloma update ASH 2014
Myeloma update ASH 2014 Updates in Newly Diagnosed Multiple Myeloma FIRST: effect of age on lenalidomide/dexamethasone vs MPT in transplantation-ineligible pts Phase III: MPT-T vs MPR-R in transplantation-ineligible
More informationTransplant in MM patients: Early versus late. Mario Boccadoro. Barcelona
Transplant in MM patients: Early versus late Barcelona 8-9-2012 Mario Boccadoro DIVISIONE UNIVERSITARIA DI EMATOLOGIA AZIENDA OSPEDALIERA SAN GIOVANNI TORINO, ITALY Transplant in MM patients: Early versus
More informationMULTIPLE MYELOMA. TREATMENT in 2017 MC. VEKEMANS
MULTIPLE MYELOMA TREATMENT in 2017 MC. VEKEMANS NATURAL HISTORY of MM WHO SHOULD BE TREATED? DEFINITION MGUS Smouldering Multiple Myeloma Symptomatic Multiple Myeloma Monoclonal component (blood and/or
More informationTerapia del mieloma. La terapia di prima linea nel paziente giovane. Elena Zamagni
Terapia del mieloma La terapia di prima linea nel paziente giovane Elena Zamagni Istituto di Ematologia ed Oncologia Medica Seràgnoli Università degli Studi di Bologna Newly diagnosed MM Candidate for
More informationAntibodies are a standard part of first relapse management in multiple myeloma (MM): Yes
Antibodies are a standard part of first relapse management in multiple myeloma (MM): Yes Ajay Nooka, MD MPH FACP Assistant Professor, Division of Bone Marrow Transplant Winship Cancer Institute, Emory
More informationIl trattamento del Mieloma su stratificazione di rischio: è oggi possibile?
Il trattamento del Mieloma su stratificazione di rischio: è oggi possibile? Francesca Gay, MD Divisione Ematologia 1 AO Città della Salute e della Scienza, Torino, Italy Focus sul MM 2014 Cagliari, 30-31
More informationGetting Clear Answers to Complex Treatment Challenges in Multiple Myeloma: Case Discussions
Getting Clear Answers to Complex Treatment Challenges in Multiple Myeloma: Case Discussions Friday, December 8, 2017 Atlanta, Georgia Friday Satellite Symposium preceding the 59th ASH Annual Meeting &
More informationTo Maintain or Not to Maintain? Lymphoma and Myeloma 2015 Waldorf Astoria Hotel, New York
To Maintain or Not to Maintain? Lymphoma and Myeloma 2015 Waldorf Astoria Hotel, New York Sundar Jagannath Director, Multiple Myeloma Program Tisch Cancer Institute Mount Sinai Medical Center Maintenance
More informationOncology Highlights ASCO 2011 MULTIPLE MYELOMA
Oncology Highlights ASCO 211 MULTIPLE MYELOMA July 211 Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida Joseph Mikhael, MD, MEd, FRCPC Staff Hematologist, Mayo Clinic Arizona Disclosures
More informationHow to Integrate the New Drugs into the Management of Multiple Myeloma
How to Integrate the New Drugs into the Management of Multiple Myeloma Carol Ann Huff, MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins NCCN.org For Clinicians NCCN.org/patients For Patients
More informationUK MRA Myeloma XII Relapsed Intensive Study CI: Prof Gordon Cook
UK Myeloma Research Alliance Myeloma XII study (ACCoRD): Augmented Conditioning & Consolidation in Relapsed Disease UK MRA Myeloma XII Relapsed Intensive Study CI: Prof Gordon Cook Sponsor ID: Pending
More informationNovel treatment strategies for multiple myeloma: a focus on oral proteasome inhibitors
Novel treatment strategies for multiple myeloma: a focus on oral proteasome inhibitors Antonio Palumbo M.D. Takeda Pharmaceuticals International AG Introduction Multiple genetically-distinct subclones
More informationInduction Therapy in Transplant Eligible MM 2 December Tontanai Numbenjapon, M.D.
Induction Therapy in Transplant Eligible MM 2 December 2017 Tontanai Numbenjapon, M.D. What we need from induction therapy in NDMM Depth of response: MRD-negative, scr, CR Longest response Acceptable toxicity
More informationGetting Clear Answers to Complex Treatment Challenges in Multiple Myeloma: Case Discussions
Getting Clear Answers to Complex Treatment Challenges in Multiple Myeloma: Case Discussions Friday, December 8, 2017 Atlanta, Georgia Friday Satellite Symposium preceding the 59th ASH Annual Meeting &
More informationStem cell transplantation in elderly, but fit multiple myeloma patients
Stem cell transplantation in elderly, but fit multiple myeloma patients Mohamad MOHTY, MD, PhD Clinical Hematology and Cellular Therapy Dpt. Université Pierre & Marie Curie, Hôpital Saint-Antoine INSERM
More informationTreatment Advances in Multiple Myeloma: Expert Perspectives on Translating Clinical Data to Practice
Treatment Advances in Multiple Myeloma: Expert Perspectives on Translating Clinical Data to Practice Friday, December 2, 2016 San Diego, California This program is supported by educational grants from
More informationDaratumumab: Mechanism of Action
Phase 3 Randomized Controlled Study of Daratumumab, Bortezomib and Dexamethasone (D) vs Bortezomib and Dexamethasone () in Patients with Relapsed or Refractory Multiple Myeloma (RRMM): CASTOR* Antonio
More informationIMiDs (Immunomodulatory drugs) and Multiple Myeloma
www.comtecmed.com/comy comy@comtecmed.com IMiDs (Immunomodulatory drugs) and Multiple Myeloma Xavier Leleu Service des Maladies du Sang Hôpital Huriez, CHRU, Lille, France www.comtecmed.com/comy comy@comtecmed.com
More informationIs autologous stem cell transplant the best consolidation after initial therapy?
Is autologous stem cell transplant the best consolidation after initial therapy? William Bensinger, MD Professor of Medicine, Division of Oncology University of Washington School of Medicine Director,
More informationMultiple myeloma, 25 (45) years of progress. The IFM experience in patients treated with frontline ASCT. Philippe Moreau, Nantes
Multiple myeloma, 25 (45) years of progress The IFM experience in patients treated with frontline ASCT Philippe Moreau, Nantes Shibata T. Prolonged survival in a case of multiple myeloma treated with high
More informationMichel Delforge Belgium. New treatment options for multiple myeloma
Michel Delforge Belgium New treatment options for multiple myeloma Progress in the treatment of MM over the past 40 years 1962 Prednisone + melphalan 1990s Supportive care 1999 First report on thalidomide
More informationMaintenance therapy after autologous transplantation
Maintenance therapy after autologous transplantation Sonja Zweegman MD PhD Department of Hematology Amsterdam The Netherlands Disclosures Research funding from Celgene, Takeda and Janssen Participation
More informationBest of ASH 2017 DR. BRIAN DURIE. Brian GM Durie, MD Thursday, January 11, 2018
Best of ASH 2017 DR. BRIAN DURIE Brian GM Durie, MD Thursday, January 11, 2018 1 ASH Overview 2017 Total myeloma abstracts: 981 Important/Interesting: oral ~40 posters ~60 100 2 Which abstracts impact
More informationLiving Well with Myeloma Teleconference Series Thursday, March 24 th :00 PM Pacific/5:00 PM Mountain 6:00 PM Central/7:00 PM Eastern
Living Well with Myeloma Teleconference Series Thursday, March 24 th 216 4: PM Pacific/5: PM Mountain 6: PM Central/7: PM Eastern Speakers Dr. Brian Durie, IMF Chairman Cedars Sinai Samuel Oschin Cancer
More informationMultiple Myeloma: Induction, Consolidation and Maintenance Therapy
Multiple Myeloma: Induction, Consolidation and Maintenance Therapy James R. Berenson, MD Medical & Scientific Director Institute for Myeloma & Bone Cancer Research Los Angeles, CA Establish the Goals of
More informationUpdates in Multiple Myeloma: 12 months in 10 minutes
Updates in Multiple Myeloma: 12 months in 10 minutes Aaron Rosenberg MD, MS Assistant Prof. Medicine UC Davis Comprehensive Cancer Center Division of Hematology and Oncology Outline Standard of care for
More informationRole of Maintenance and Consolidation Therapy in Multiple Myeloma: A Patient-centered Approach
Role of Maintenance and Consolidation Therapy in Multiple Myeloma: A Patient-centered Approach Jacob Laubach, MD Assistant Professor in Medicine Harvard Medical School Clinical Director of the Jerome Lipper
More informationChoosing upfront and salvage therapy for myeloma in the ASEAN context
Choosing upfront and salvage therapy for myeloma in the ASEAN context Daryl Tan Consultant Department of Haematology Singapore General Hospital Adjunct Assistant Professor Duke-NUS Graduate Medical School
More informationAperTO - Archivio Istituzionale Open Access dell'università di Torino
AperTO - Archivio Istituzionale Open Access dell'università di Torino Complete response correlates with long-term progression-free and overall survival in elderly myeloma treated with novel agents: analysis
More informationStudy Objectives: GMMG MM5
Study Objectives: GMMG MM5 1.) Demonstration of non-inferiority of VCD induction therapy compared to PAd induction therapy with respect to response rate (very good partial remission or better; response
More informationMethods: Studies included in the analysis
Efficacy and safety of long-term ixazomib maintenance therapy in patients with newly diagnosed multiple myeloma not undergoing transplant: An integrated analysis of four phase 1/2 studies Meletios A. Dimopoulos,
More informationPost Transplant Maintenance- for everyone? Disclosures
Post Transplant Maintenance- for everyone? NO Because of limited survival data, not all patients require maintenance April 2012 Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida Joseph Mikhael,
More informationHow I Treat Transplant Eligible Myeloma Patients
How I Treat Transplant Eligible Myeloma Patients Michele Cavo Seràgnoli Institute of Hematology, Bologna University School of Medicine, Italy Podcetrtek, Slovene, April 14 th, 2012 NEW TREATMENT PARADIGM
More informationNovel Treatment Advances and Approaches in Management of Relapsed/Refractory Multiple Myeloma
Novel Treatment Advances and Approaches in Management of Relapsed/Refractory Multiple Myeloma Ravi Vij, MD MBA Professor of Medicine Washington University School of Medicine Section of Stem Cell Transplant
More informationMyeloma and renal failure Future directions. Karthik Ramasamy
Myeloma and renal failure Future directions Karthik Ramasamy Overview Historical perspective & Background Drug interventions & trials OPTIMAL Trial Future directions Burden of disease Upto 40% of newly
More informationClinical Case Study Discussion: Maintenance in MM
www.comtecmed.com/comy comy@comtecmed.com Evangelos Terpos, MD, PhD National & Kapodistrian University of Athens, School of Medicine, Athens, Greece Clinical Case Study Discussion: Maintenance in MM Disclosure
More informationCurrent treatment options for relapsed/refractory multiple myeloma in practice
Current treatment options for relapsed/refractory multiple myeloma in practice Professor Marίa-Victoria Mateos University Hospital of Salamanca, Salamanca, Spain Please note that discussion throughout
More informationMultiple Myeloma Updates 2007
Multiple Myeloma Updates 2007 Brian Berryman, M.D. Multiple Myeloma Updates 2007 Goals for today: Understand the staging systems for myeloma Understand prognostic factors in myeloma Review updates from
More informationCurrent management of multiple myeloma. Jorge J. Castillo, MD Assistant Professor of Medicine Harvard Medical School
Current management of multiple myeloma Jorge J. Castillo, MD Assistant Professor of Medicine Harvard Medical School JorgeJ_Castillo@dfci.harvard.edu Multiple myeloma MM is a plasma cell neoplasm characterized
More informationMULTIPLE MYELOMA AFTER AGE OF 80 YEARS
MULTIPLE MYELOMA AFTER AGE OF 80 YEARS C. Hulin CHU Nancy, France Intergroupe Francophone du Myelome (IFM) Epidemiology SEER Program between 1990-2004: 17 330 MM cases, 51% 70 y and 20% 80 y. Brenner et
More informationMultiple Myeloma Brian Berryman, M.D. March 8 th, 2014
Multiple Myeloma 2014 Brian Berryman, M.D. March 8 th, 2014 Kyle, R. A. et al. Blood 2008;111:2962-2972 Updates in Multiple Myeloma CCO Independent Conference Coverage of the 2013 Annual Meeting of
More informationMeu paciente realizou um TACTH na 1a linha, e agora? Tandem, Manutenção, Consolidação? Marcelo C Pasquini, MD, MS Medical College of Wisconsin
Meu paciente realizou um TACTH na 1a linha, e agora? Tandem, Manutenção, Consolidação? Marcelo C Pasquini, MD, MS Medical College of Wisconsin Post Auto HCT Options for MM Maintenance Lenalidomide vs.
More informationTherapie des Multiplen Myeloms Alles im Fluss? Peter Neumeister, MD Division Hematology Medical University Graz
Therapie des Multiplen Myeloms Alles im Fluss? Peter Neumeister, MD Division Hematology Medical University Graz 15.6.218 Newly Diagnosed Multiple Myeloma Transplant Eligible NDMM TE VCD is preferable to
More informationMantle cell lymphoma An update on management
Mantle cell lymphoma An update on management Dr Kim Linton Consultant Medical Oncologist The Christie NHS Foundation Trust 6 th October 2016 This educational meeting is organised and sponsored by Janssen-Cilag
More informationCurrent Management of Multiple Myeloma. December 2012 Kevin Song MD FRCPC Leukemia/BMT Program of B.C.
Current Management of Multiple Myeloma December 2012 Kevin Song MD FRCPC Leukemia/BMT Program of B.C. Disclosures Honoraria Speaker Celgene, Janssen, Novartis Celgene, Janssen Research Support Celgene
More informationNovel Therapies for the Treatment of Newly Diagnosed Multiple Myeloma
Novel Therapies for the Treatment of Newly Diagnosed Shaji K. Kumar, MD Professor of Medicine Mayo Clinic College of Medicine Consultant, Division of Hematology Medical Director, Cancer Clinical Research
More informationConsolidation after Autologous Stem Cell Transplantion
Consolidation after Autologous Stem Cell Transplantion Joan Bladé Laura Rosiñol Department of Hematology Hospital Clínic de Barcelona Berlin, September 11 th 2011 Autologous Stem Cell Transplant in Younger
More informationManagement of Multiple Myeloma: The Changing Paradigm
Management of Multiple Myeloma: The Changing Paradigm High-Dose Chemotherapy and Stem Cell Transplantation Todd Zimmerman, MD University of Chicago Medical Center Case Presentation R.M. is a 64 year old
More informationIs Transplant a Necessity or a Choice: Focus on the necessity for CR and MRD
Is Transplant a Necessity or a Choice: Focus on the necessity for CR and MRD Ajai Chari, MD Associate Professor of Medicine Director of Clinical Research Multiple Myeloma Program Mount Sinai Medical Center
More informationInduction Therapy & Stem Cell Transplantation for Myeloma
Induction Therapy & Stem Cell Transplantation for Myeloma William Bensinger, MD Professor of Medicine, Division of Oncology University of Washington School of Medicine Director, Autologous Stem Cell Transplant
More informationHighlights in multiple myeloma
3 CONGRESS HIGHLIGHTS Highlights in multiple myeloma P. Vlummens, MD SUMMARY Multiple myeloma (MM) remains a devastating disease, even in the era of novel agents. As such, the search for new treatment
More informationMYELOMA MAINTENANCE BEST PRACTICES:
MYELOMA MAINTENANCE BEST PRACTICES: POST THERAPY & POST TRANSPLANT Aric Hall, MD Assistant Professor University of Wisconsin Hospital and Clinics INTRODUCTION MYELOMA Clonal plasma cell malignancy leading
More informationMAINTENANCE AND CONTINUOUS THERAPY OF MYELOMA. Myeloma Day 11/18/2017 Aric Hall, MD Assistant Professor UW School of Medicine & Public Health
MAINTENANCE AND CONTINUOUS THERAPY OF MYELOMA Myeloma Day 11/18/2017 Aric Hall, MD Assistant Professor UW School of Medicine & Public Health Disclosures I have no significant conflicts of interest to disclose.
More informationSmoldering Myeloma: Leave them alone!
Smoldering Myeloma: Leave them alone! David H. Vesole, MD, PhD Co-Director, Myeloma Division Director, Myeloma Research John Theurer Cancer Center Hackensack University Medical Center Prevalence 1960 2002
More informationeligible for the triplet therapy if they had not previously progressed during treatment with bortezomib. Additionally, patients previously treated with lenalidomide and Dex were eligible for the triplet
More informationRole of Stem Cell Transplantation in Multiple Myeloma: The Changing Landscape
Role of Stem Cell Transplantation in Multiple Myeloma: The Changing Landscape Simrit Parmar, MD MDACC Houston, TX, USA Why Transplant in the Era of Novel Therapy? Safe (TRM
More informationExperience with bortezomib (Velcade) in multiple myeloma. Peter Černelč Clinical center Ljubljana Department of Haematology
Experience with bortezomib (Velcade) in multiple myeloma Peter Černelč Clinical center Ljubljana Department of Haematology Our experience with bortezomib (Velcade) in multiple myeloma 1. Our first experience
More informationRelapsed Myeloma Sequencing Treatments
Relapsed Myeloma Sequencing Treatments Noopur Raje, MD Director, Center for Multiple Myeloma MGH Cancer Center Professor of Medicine Harvard Medical School Disclosures Consultant /Advisory Board: Celgene,
More informationFOR IMMEDIATE RELEASE
FOR IMMEDIATE RELEASE FOR UK MEDICAL AND TRADE MEDIA ONLY Takeda Presents Data from TOURMALINE-MM1 Study for Ixazomib, the First and Only Once-Weekly Oral Proteasome Inhibitor Studied in Phase III Clinical
More informationKalyan Nadiminti, MBBS 4/13/18
A Single Autologous Stem Cell Transplant (ASCT) followed by two years of post-transplant therapy is safe in Older Recently Diagnosed Multiple Myeloma (MM) Patients. Preliminary Results from the Prospective
More informationDebate: Is transplant a necessity or a choice? Focus on the necessity for CR and MRD. Answer: NO
Debate: Is transplant a necessity or a choice? Focus on the necessity for CR and MRD. Answer: NO Tomer M. Mark Department of Medicine, Division of Hematology / Oncology Weill-Cornell Medical College /
More informationDisclosures. Consultancy, Research Funding and Speakers Bureau: Celgene Corporation, Millennium, Onyx, Cephalon
Pomalidomide With or Without Low-dose Dexamethasone in Patients With Relapsed/Refractory Multiple Myeloma: Outcomes in Patients Refractory to Lenalidomide and Bortezomib Ravi Vij 1, Paul G. Richardson
More informationMultiple Myeloma What is New? Can we talk cure? Rafat Abonour, M.D.
Multiple Myeloma What is New? Can we talk cure? Rafat Abonour, M.D. Multiple Myeloma Facts Second most prevalent hematologic neoplasm Nearly 24, new cases diagnosed in the US per year and 11, worldwide
More informationThe TOURMALINE-MM1 study: results and expert insights
The TOURMALINE-MM1 study: results and expert insights Professor Faith Davies UAMS Myeloma Institute, Arkansas, USA This educational meeting was organised and fully funded by Takeda UK Ltd. Takeda medicines
More informationMultiple Myeloma: ASH 2008
Multiple Myeloma: ASH 2008 Steven Coutre, M.D. Associate Professor of Medicine Division of Hematology Stanford University School of Medicine About These Slides These slides accompany CCO s comprehensive
More informationNew IMWG Response Criteria
New IMWG Response Criteria Shaji Kumar, M.D. Professor of Medicine Division of Hematology Mayo Clinic Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida Mayo Clinic College of Medicine Mayo
More informationVI. Autologous stem cell transplantation and maintenance therapy
Hematological Oncology Hematol Oncol 2013; 31 (Suppl. 1): 42 46 Published online in Wiley Online Library (wileyonlinelibrary.com).2066 Supplement Article VI. Autologous stem cell transplantation and maintenance
More informationRisk of Second Primary Malignancies (SPMs) Following. Bortezomib (Btz)-Based Therapy: Analysis of Four Phase 3
ASH2933 Risk of Second Primary Malignancies (SPMs) Following Bortezomib (Btz)-Based Therapy: Analysis of Four Phase 3 Randomized Controlled Trials in Previously Untreated or Relapsed Multiple Myeloma (MM)
More informationManagement of Multiple Myeloma
Management of Multiple Myeloma Damian J. Green, MD Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance New Treatment Options Have Improved OS in MM Kumar SK, et al. Blood. 2008;111:2516-2520.
More informationMyeloma care and proteasome inhibitors. Brendan M. Weiss, MD Abramson Cancer Center University of Pennsylvania
Myeloma care and proteasome inhibitors Brendan M. Weiss, MD Abramson Cancer Center University of Pennsylvania Why care about CV toxicities in MM? Median age 72 years About 2/3 have CV disease at baseline
More information