Interesting new take on Multiple Myeloma

http://www.mpatient.org/dr-saad-usmani-2/

Summary
Dr. Saad Usmani is the new director of the Plasma Cell Disorder program and the director of Clinical Research in Hematology myeloma program at the Levine Cancer Institute. He shares three key lessons he learned through his work at UAMS: all myeloma is different and the effectivity of the most used drugs will vary from one patient to the next; about 10-15% of myeloma patients are high-risk and resistant to most of these therapies; there is a big disparity in clinical trial access especially for racial minorities. He defines “high-risk” by clarifying that high-risk smoldering myeloma is the risk to progression to active myeloma, while the risk for a newly diagnosed myeloma patient is the risk to relapse after treatment has been given. He defines the highest risk features as being deletion 17p, translocation (14;16), translocation (14;20), and amplification of chromosome 1q21. Although the 4;14 translocation has been known to be a high risk feature, he notes that if bortezomib is used in therapy, these patients can have similar outcomes to normal risk patients, so 4;14 can be an intermediate risk factor. He gave a very clear explanation of the GEP test and other tests needed to determine risk and relapse. He shared his experience at UAMS showing that many high-risk patients getting transplant and even double transplant relapse quickly, so he prefers to use clinical trials and newer drugs instead of a melphalan-based treatment because of toxicity issues. He shares the first ever clinical trial specifically designed for newly diagnosed high-risk myeloma patients with del17, 4;14 and 14;20 that has two arms – the first uses Revlimid-Velcade-dexamethasone and the second uses Revlimid-Velcade-dexamethasone with a newer monoclonal antibody that targets the CS1 protein called elotuzumab. He describes how and why the trial was constructed. This SWOG 1211 trial is available in the US and in Canada and is the first major trial to address the needs of high-risk patients. He now provides deep myeloma expertise in the Charlotte and surrounding area for an underserved patient population.
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