Dr. Guido Tricot, MD, PhD University of Iowa Interview Date: December 5, 2015 

Dr. Tricot joins Myeloma Crowd Radio from the ASH 2015 conference in Orlando to talk about high risk myeloma. While standard treatments have become much more effective, 15-20% of patients have high risk disease and are not gaining longer life, even with the newer combinations. He notes the difference between more mature myeloma cells, which can't propogate the disease vs. the myeloma stem cells, but notes that if there is a large tumor burden, the sheer amount can create disease increase. Because the quanitity of cells can cause growth, he suggests that patients move to immediate transplant so they are hit with aggressive treatment when they are still naive to the drugs. One of the most important things patients can do with high risk disease is to make sure that the treatments are given on time with short induction periods. Dr. Tricot shares experience from the Total Therapy studies that patients with 17p deletion benefit with proteasome inhibitors like bortezomib and notes that they should also be used as maintenance therapy where iMiDs may actually be detrimental as maintenance. He has hope for checkpoint inhibitors and is looking forward to incorporating the new monoclonal antibodies in addition to standard treatments. He clarifies the definition of high-risk in patients with del13. He is focusing on new treatments for the MAF translocations using a Notch 2 inhibitor and is working on identifying a marker using flow cytometry that identifies response to treatment. Once tested, it would identify patients who have responded and or not responded and would help determine the course of treatment.

Thanks to our episode sponsor Takeda Oncology