IMS Updates | Saad Usmani, MD, FACP | IMS 2022

Hello, my name is Saad Usmani. I'm the chief of the myeloma service at Memorial Sloan Kettering Cancer Center, and I'm here at the 19th annual International Myeloma Society meeting in Los Angeles. It's our first live meeting of this nature that's going to be happening on an annual basis from here on. The format of the meeting has been modified from previous editions to include a lot of sessions where we are looking at both the science and clinical data in the context of where the field is and then trying to have a discussion around all of that information and trying to make sense of, okay, where do we go from here in the field? We have a lot of participation from both senior as well as junior investigators. That's actually been the highlight of this meeting so far is seeing so many young people presenting wonderful data and interacting with the more senior people and coming up with new ideas. This has been a meeting full of hope. The fact that it's focused on myeloma only and there are around 1,700 of us here live and another 700 or 800 who are following us virtually, we can walk out of the hall and strike up a conversation and discuss ideas. What's most exciting from a data perspective for me at the meeting is seeing both good data on understanding the myeloma cell biology as well as what's happening to the immune system as patients go from having a precursor disease like M. gus or small ring myeloma to active disease and then also looking at what the immune system does if patients have very deep MRD responses versus those who might be losing that response. We also had really nice sessions with newer therapies such as Bi-Specifics and CAR T's and we're learning about some of the side effects that we have to watch out for, some patterns of infections that we discussed quite a lot in the immune reconstitution session. And then we are also learning about the newer CAR T cell and cellular therapies in terms of targets and then are there ways in which we can predict for deeper responses or ways in which we can predict for patients who will not have a good response. Some interesting data where new mechanisms of action such as a specific mutation in the BCMA gene that may actually potentially be identified in patients. So I'm just giving snippets of the key information. One thing that's coming out for sure from this interaction, all of us agree that the quadruplet inductions would be the way to go. Transplant still remains very important for frontline patients, especially for high risk patients and we are also having discussions that in the future we really need to do clinical that are able to replace transplants head to head but they need to be cellular therapy or maybe Bi-Specific therapy based. So we have to start really thinking about that next generation of consolidative treatments post induction and doing more focused efforts for high risk patients. Some of the clinical trials that have been discussed in closed sessions, not in the open sessions, the ones that were felt to be most exciting are trials where patients have sustained MRD negativity and we are opting to stop treatment compared to the standard of care of continuing therapy on those patients. So there are maintenance trials, the SWOG-1803 study is an example. It's a big study. You know, 1,200 patients are going to be enrolled on that study and after three years of having maintenance, if they have MRD negativity, they are going to be randomized to either stopping treatment or continuing treatment. And it's those kind of studies that will help us in defining how long we need to keep patients on maintenance treatment. And they will also inform other trials where we can even shorten that duration further. You know, and there was a lot of discussion around curability of myeloma and how we can define duration of treatment based off of sustained MRD negativity. So, you know, very exciting stuff. Lastly, you know, the most exciting part of this meeting really has been, you know, coming and meeting all my colleagues and rekindling those collaborations. You know, you don't get that feel when you're in a Zoom call where you can just sit down with a colleague and talk about an idea and brainstorm things. So it's not the same. So I'm really looking forward to future meetings of this nature.