Last Few Hours at ASH

| Anne Pacowta

There are only a few abstracts left to attend, and every one we listened to were excellent.
Yesterday, the focus of our attendance was on advances in myeloma.

Because I have an interest in educating myself about smoldering multiple myeloma (SMM), I was eager to hear the latest studies on this subject.

Dr. Rajkumar’s presentation, “When does Smoldering become open flame?” really put “light” on the subject.

He began with some definitions of smoldering:
-Burn without flame
-Hatred beneath polite surface

I can see how both of those can relate to SMM.

To distinguish between SMM and MM, monoclonal gammopathy of undetermined significance (MGUS) and SMM have no CRAB symptoms. CRAB criteria is the following:

[C] Calcium elevation in the blood S. Calcium >10.5 mg/l or upper limit of normal{}
[R] Renal insufficiency S. Creatinine > 2 mg/dl{}
[A] Anemia Hemoglobin < 10 g/dl or 2 g < normal{}
[B] Lytic bone lesions or osteoporosis—If a solitary (biopsy-proven) plasmacytoma or osteoporosis alone (without fractures) are the sole defining criteria, then > 30% plasma cells are required in the bone marrow.)

To distinguish between SMM and MM, MGUS & SMM have no CRAB symptoms, a fact commonly known among all MM patients; however, it is now thought that SMM is a mix of MGUS & MM.

MGUS advances at 1% per year and SMM at 10% per year. Now we need to look at SMM differently.

Dr. Rajkumar went on to state that we need to revise our criteria for SMM, use CT and Pet CT to diagnose before bone damage, not wait for MM markers to treat, and consider clinical trials for these patients.

The morning abstracts continued with information on maintenance and consolidation, novel combinations and transplantation, which I’m sure other bloggers will cover.

Minimal Residual Disease (MRD) testing was a common topic, also two- as opposed to three- agent treatment.

This morning, Monday, novel therapies were the topic.

Two new drugs, KEYTRUDA® (pembrolizumab) and isatuximab are in clinical trials and daratumumab in trials with combinations. Again, I’m sure other bloggers will tackle these.

So there is great news on the horizon. Have patience and faith. More to come.

I’ll soon be home, relax and try to digest all the great news I’ve just heard.


by Anne Pacowta

Follow Anne on Twitter: @IMFsupportANNE
The North Florida Area Multiple Myeloma Support Group
Jacksonville, FL

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