When I started at Hopkins, the good Dr. Matsui was my boss. And he sat me down, “You’re coming in from the NIH. What do you want to do?” “Not quite sure, don’t really know what I want to do with my life. That’s when I said, what do you want to do?” Dr. Matsui said, “I want to cure multiple myeloma.”
— Syed Abbas Ali, Johns Hopkins University
You know that feeling you get after seeing a great movie, but one scene won’t let go of you? That’s what it was like if you attended the Austin Myeloma Round Table on March 25, 2023. But to paraphrase former sportscaster Warner Wolf, we can go to the videotape.
Dr. William Matsui’s stressed Dr. Hans Lee's “super important” observation in the closing discussion be clearly understood, that some physicians are “dogmatic: ‘you know what, this is how you do things, I know how to do it, I’m right, I was a pioneer, I know how to do it.’…and then you say, ‘well, there’s this data that suggests that that’s not right.’ And they say, ‘but that data is wrong, I know what is right, blah, blah.’ And so I think these fellows (pointing out his fellow speakers) are great because they think about data.
“If new data comes, we need to use that,” he continued, “so I think using it, thinking about how it fits into your practice…I think that if you can come up with a way of doing things and defend it in a very objective, data-driven way, I think that’s a reasonable way to go, no matter how you choose it. The things we don’t want are doing something” because someone else is doing it.” It summed up the themes of the day.
Matsui opened the day with Why Stem Cells Matter, a clear, lay language explanation of an incredibly vital issue in myeloma that literally affects every part of diagnosis and treatment. Matsui, a world recognized expert on stem cell biology, had not shared this level of basic understanding in a patient lecture before.
“It is estimated that we have about 100,000 of these stem cells in us, but every day we need to make 90 billion blood cells to replace the ones we’ve lost,” said Matsui, “so we have 100,000 that we get at the beginning of our lives, and they have to last for however long we last…they’ve just got to live longer than you because they need to produce blood the entire time.”
The chain of biological events causing myeloma happen in the plasma or B cells. Matsui continued, “this is a super-fine-tuned system. If you increase it just by a little bit, you’re going to have leukemia. If you decrease it by just a little bit, you’re going to have anemia and all these other problems.”
Matsui explains why this matters in therapies that target plasma and B cells differently. The art of therapy is to find a balance that works for each individual characteristic.
But ultimately it comes down to data, experience, and what the biology of each patient reveals to physicians based on the tests available, as a discussion among the full faculty that closed the presentations. Each speaker described how they put the information together in an ever-changing treatment environment with new tests and therapies being added or refined every year.
All the videos can be accessed here.
Dr. Syed Abbas Ali from Johns Hopkins discussed strategies to extend remission after treatment, something that matters more and more to patients who have had lines of treatment or fallen into relapse. He cautioned about putting too much reliance on minimal residual status. It could be helpful, but no consensus about interpreting it to direct therapy exists, although data does favor those with standard-risk disease, something backed up by Matsui in the second audience Q&A session.
Ali compared sustained remission of transplant and CAR T therapy and how research to use vaccines in some patients to extend remissions. He closed with an examination of how BCMA-targeted therapies are being applied.
Ali closed the presentations of the morning session leading a discussion of three case studies with the other speakers in Essential Treatment Concepts Easily Forgotten to better understand how to physicians approach treatment of individual patients. He was preceded by three talks that laid out the process of how physicians treat newly diagnosed and relapsed/refractory myeloma.
The morning session began with Putting Your Disease Into Your Context. Dr. Matsui explained how, although myeloma has standard therapies, treating patients is a doctors way of solving a particular problem. Despite the existence of standard therapies, one’s individual disease may need other options.
Matsui laid out how physicians approach each case, making this presentation invaluable for newly diagnosed patients and their caregivers.
Dr. Matthew Butler from UT San Antonio outlined why myeloma is not a one-size-fits-all disease and the good news of more treatment choices creates the uncertainty of deciding which is best and in what order in So Many Choices: Deciding Which Treatment is Best. His presentation described the myriad of connections physicians must sort out for each individual patients.
Butler explained how data from clinical trials refines decision-making and gives both physicians and patients more confidence about treatment, which is essential in any treatment plan. He began the day by conducting an Introduction to Myeloma session for novices, a new feature for attendees of Myeloma Round Tables.
Dr. Hans Lee from MD Anderson Cancer Center in Houston closed the morning presentations to show how Moving Novel Concepts Toward Front-Line Treatment is occurring and how it might change in the foreseeable future. He explains basic concepts that all patients should understand like what is line of therapy, refractory, or how it is determined to move an effective therapy more accessible to earlier lines of therapy.
His presentation picked up the themes explained by Matsui and Butler and how they are implemented in the clinic. He stressed the importance of understanding today’s therapies and putting tomorrow’s expected paradigm changes in perspective, to be ready when the time is right.
Both the morning session and the afternoon session ended with audience questions and faculty panel answers. The questions are listed and time-stamped in the link to each.
about the author
Greg Brozeit has been with the HealthTree Foundation since 2015 when he began volunteering for the Myeloma Crowd. Prior to that he worked with Dr. Bart Barlogie and the International Myeloma Foundation, inaugurating many myeloma patient advocacy and education programs.
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