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Understanding and Maximizing Myeloma Treatment Approaches

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Published on August 9, 2016

What is the role of transplant in treatment of multiple myeloma? From our town meeting in Little Rock, Arkansas, in partnership with UAMS Myeloma Institute, myeloma expert Dr. Gareth Morgan shares his perspective. Listen as Dr. Morgan discusses the vital and ongoing role of transplant as well as doublet, triplet and quadruplet combination therapies for myeloma. According to Dr. Morgan, the time has come to address a deeper understanding of cure and long-term control of this disease.

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Transcript | Understanding and Maximizing Myeloma Treatment Approaches

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Hello and welcome to Patient Power.  I'm Andrew Schorr.  We are here at the University of Arkansas for Medical Sciences, a big complex in the really world?renowned myeloma institute here, and one of the guiding lights now is Dr. Gareth Morgan, who joins us.  Thank you so much for being with us. 

Dr. Morgan:

Good to see you. 

Andrew Schorr:

Dr. Morgan, there's been just a tremendous growth in the number of treatments for myeloma, and we've been thinking about what's right for what patient. But one of the things that was pioneered here was really transplant along with medicines to really try to eradicate to or really knock back the disease, give people long remissions.  And then there's been a debate about whether transplant still has a role.  What's your view here?

 

Dr. Morgan:

It's completely clear that transplant still has a role, and that's just not my opinion.  I think we should build new treatments into a transplant backbone, and the reason for that is just recently people have done the experiment and tried to drop transplantation, and the DFCI/IFM study clearly shows that the progression?free survival is less if you drop the transplant.  And so the backbone of therapy, therefore, becomes the transplant, and how do you take a novel drug. So targeted treatments or immunotherapies, build them into that background so that we keep moving forward and don't take a step backwards.

Andrew Schorr:

Now, transplant isn't for everybody, so you have to assess somebody's health status, and you have to see, look at their own character of myeloma, so how do you do that analysis? 

Dr. Morgan:

So I think there are misconceptions about how treatment is delivered, and you always have to look at the patient and personalize the approach to the patient that's sitting in front of you. And that means you don't say, oh, it's a triplet this or a quadruplet that or a doublet this.  It's about what's the best way to get them into a remission. And then if they're not responding to that triplet, say, that you swap to a different triplet that has a different mode of action and continues to get them responding.

And so the treatment aim in some way or other is to maximize response rates, to maximize the depth of response, and then both for younger and older patients and to hold them in remission for as long as you can. And we take an arbitrary cut point of three years.  So if any of the cells, the residual cells that are there, wake up, you kill them off before they relapse as clinical disease. 

And that type of strategy works beautifully for younger patients where you can use more intensive chemo protocols but also works for the elderly and less robust where you can either reduce the dose of chemotherapy or use these novel agents.  So that's the type of theoretical approach to treatment that I believe myeloma doctors should be taking these days.

Andrew Schorr:

And you used some terms, doublet and triplet and quadruplet.  You have more notes on the piano you can play together now as chords than ever before, monoclonal antibodies that have been approved and others coming along that could go along with oral therapies or infused therapies and transplant. 

Dr. Morgan:

Absolutely.  

Andrew Schorr:

So it's really complicated. 

Dr. Morgan:

So I like the idea of chords, okay.  So I was conceptualizing them as almost as cassettes of treatment.  We know from biological studies that if you use one agent, the cancer will find a way to become resistant to it really quite quickly.  If you give it a chord or four drugs, three drugs, and then mix and match, what you end up is totally confusing it so that almost all of the cells are killed.  And then you use the maintenance or longer term treatment to mop up any cells that are left.  And that really is the future of myeloma treatment.

And this endless debate about cure or control still rumbles on in the background, but I think we should be really thinking about kill and long?term control in the same sentence really because it's all about maximizing response to minimal residual disease states and then monitoring the disease when there's almost nothing there. 

And we've spent some time generating the tools to do that, and now it's a process of convincing the FDA that this really is what we should do, analogous to CLL, where we kind of started doing this years ago.  MRD testing becomes an end point for clinical trials, speeds up the whole process, and the faster we can lever drugs into the myeloma arena, the quicker we're going to make progress for patients.

Andrew Schorr:

Okay.  So much more to talk about, and we're here at the University of Arkansas doing an event, so we hope you'll look at those video clips as well, and we'll talk more about minimal residual disease measurement and how we can speed up drug development.  But thank you for all you do here. 

Dr. Morgan:

Thanks ever so much.

Andrew Schorr:

Pleasure to have you.  Andrew Schorr with Dr. Gareth Morgan helping lead the way so that you get the right treatment, combining, using transplant when appropriate, so that that gets down to that low level, and hopefully effectively not only is your myeloma controlled but maybe with the hope that it's cured. 

Remember, knowledge can be the best medicine of all.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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