In-between Dr. San-Miguel’s smoldering myeloma presentation and Dr. Durie’s presentation about treating patients that aren’t stem cell transplant candidates, an animated, emotional exchange took place among panel participants.
Specifically, Dr. San-Miguel strenuously objected to using X-rays alone to warn of possible bone involvement in smoldering myeloma patients. He made the same point that I reported on this summer in Dallas. There, Dr. Durie discussed the inaccuracies of X-ray bone surveys when compared to MRI and/or PET scans with a group of myeloma support group leaders:
A short diagnostic imaging primer, courtesy of Dr. Brian Durie
Dr. San-Miguel shook his fist in the air as he used the analogy of a prostate cancer patient who was forced to wait for his cancer to metastasis before being treated. He was making two points. First, that treating patients that are technically still smoldering,with some bone involvement is the right thing to do. And specifically, how important it is to identify these patients sooner using a more sensitive test.
Could some of Dr. Miguel’s frustration be caused by limits placed on imaging options in Spain? I will try and ask him about that.
Now that Dr. Durie’s presentation is nearing completion, let me summarize it by saying that a minimum of two novel therapy agents, plus dex, should be used when treating patients not eligible for stem cell transplant.
Feel good and keep smiling! Pat
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