Myeloma Therapy: From Diagnosis to Relapse

Eric Seifter, MD
Dr. Seifter is associate professor at the Johns Hopkins University School of Medicine and a hematologist in private practice at Park Medical Associates in Maryland.

This year’s Education Program takes a new approach to disease-specific content: In two Special Education Sessions, “Approach to the Treatment of the Young, Fit Patient With Myeloma: From Diagnosis to Relapse” and “Approach to the Treatment of the Older, Unfit Patient With Myeloma: From Diagnosis to Relapse,” experts will engage in a back-and-forth exchange about the optimal management.

This debate will begin with each participant stating his or her recommendations and rationales for induction therapy, hematopoietic cell transplantation/consolidation therapy, and maintenance therapy, followed by a discussion about the therapeutic choices and resulting outcomes.

Here, we speak with Eric Seifter, MD, chair of the session on the treatment of young, fit patients, about the new format and what attendees can expect to take away from the conversation.

How does this new session format differ from previous annual meetings?

Typically, there are three didactic talks, each about 20 to 25 minutes, in which a speaker explains the new diagnostic tools or methodology and therapeutic approaches in a certain disease topic. This year, we wanted to try something different; we wanted the session to mirror the daily life of a clinician who, when presented with a challenging patient scenario, weighs the pros and cons of a certain approach.

In this particular session, we will present a case and two expert speakers will walk us through their decision-making process. They will present the data supporting a certain treatment approach sequentially – based on how they would ask themselves these questions in real-world practice. As the moderator and as a clinician in private practice (not a clinical trialist or academic researcher), my job is to speak for the audience. I’ll challenge the speakers when they agree and, when they disagree, try to uncover why their recommendations differ.

It will be a somewhat freewheeling conversation about the patient case that attendees can listen in on. There won’t be the usual three separate talks at a podium – just three clinicians sitting together as they talk about how they decide to treat a patient.

In this scenario of a young, fit person with newly diagnosed myeloma, what do you expect the greatest areas of disagreement will be?

Obviously, there are many recently approved therapeutic options for induction, consolidation, and maintenance and for treating relapsed disease. The challenging question is, “How do we select from these options to optimize overall survival and quality of life?”

We also will be covering the new technologies and diagnostic strategies, like gene-expression profiling or minimal residual disease monitoring. There is no doubt that these new methods are critical for interpreting clinical trials data, but I think they still need to prove their worth in clinical practice. That’s one of the topics we’ll be debating: Can we – and should we – alter our approach based on the results of these tests, and does that lead to validated improvements in patient outcome?

For example, a gene-expression profile might tell us that a patient has high-risk disease. So, does that mean that the patient should or should not undergo hematopoietic cell transplantation in first remission? When we analyze the genomic data, we may find that patients with the most favorable prognosis are the very ones that benefit most from transplant, while those with high-risk disease don’t benefit at all.

We certainly need to gather these data to understand how to use these technologies in the future, but, at this point, we don’t know how to use all this information. That’s a major challenge for clinicians now.

What do you want people to take away from this session?

Attendees are going to hear from two leaders in the field about how they approach the same patient, and our goal is for them to walk away with practical information they can use in their clinics. I want to ask the questions in the moment that people usually ask at the end of a session. For instance, if one speaker advocates for using a certain diagnostic technology, my role will be to ask, “Well, how are we going to get paid for it, if insurance companies aren’t covering it yet?”

In that way, we’re hoping that this session will be more in tune with the audience members who come to education sessions – trainees or people new to hematology/oncology who want to expand their understanding of a certain disease topic.