Smoldering myeloma therapy debate

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For those of you that missed it, here is the link to Tuesday’s Myeloma Cure Panel online broadcast:

Gary Peterson hosts Dr. Hari and Cure Talk Panel

 

Dr. Parameswaran Hari was the guest expert on the panel.  Dr. Hari is the Clinical Director of the Adult Bone Marrow Transplant Program and Associate Professor of Medicine, Division of Hematology, and Oncology at the Medical College of Wisconsin.  I was very impressed with his detailed answers to a number of questions, including mine about whether smoldering myeloma patients are taking a risk by participating in clinical trials when they are exposed early to novel therapy agents like Revlimid and Velcade.

I argued that by  starting chemotherapy early,  smoldering patients risk developing myeloma that may become prematurely drug resistant.

I’m concerned that this approach could end-up mimicking maintenance therapy studies, where disease progression is delayed by 20 months or so.  Yet in the end, overall survival isn’t improved much.

But Dr. Hari felt that it is appropriate for smoldering patients to participate, as long as they have been identified in the “high risk” category of patients most likely to develop active disease.  He believes that hitting myeloma early results in the longest sustained remissions–and that the same principle should apply to smoldering patients, too.

In other words, hit the myeloma hard before it has a chance to get established.

Dr. Hari agrees with researchers that believe treating high risk smoldering patients could delay the onset of active myeloma by several years.

This is the same argument used by myeloma specialists that want to transplant right away–that there is a better chance of achieving a long, sustained remission.

Although the last point has been debunked by a number of clinical studies, the “hit smoldering myeloma early to help prevent it from becoming active” theory does  look more promising.

One of the panelists, Kieth Virgin, is a smoldering myeloma patient.  Kieth is a patient of Dr. Barlogie at UAMS in Arkansas, and is participating in the UAMS SWOG120 MGUS trial.

Kieth was the panels “case study,” asking Dr. Hari a number of specific smoldering myeloma related questions.  I am going to share Keith’s story with you next week.

Other topics were covered too, including Dr. Hari’s recommendations for relapsed myeloma patients.

I’m going to be hosting next month’s broadcast.  I would like to shake things up a bit, focusing on one or more controversial topics that aren’t usually given enough time during these types of programs.   I’ve proposed an evening telecast, so working patients and caregivers can listen-in and ask questions, too.  I will update you once a date and time are set.

Feel good and keep smiling!  Pat