#ASH20 was fully virtual due to the pandemic. #ASH21 will be a hybrid of virtual and in-person meetings by choice. At least that is my hope and prediction. The virtual format allowed us to log from the comfort of our home and we were at the mercy of the WIFI and not an overflowing meeting room somewhere in the obscured corner of a convention center. It allowed us to be able to skip some presentations that we were not interested in or over our head. It allowed us to rewind and replay in real time if we wanted to listen to something or think through a visual the speaker went over. Overall, it was a pleasant experience.
What are my top 10 takeaways? (not in order)
- Use your best available treatment early. According to Dr. Joe, the 1, 2 punch of initial and 1st relapse treatment are prognostic of outcome.
- Careful sequencing of treatments, when available guided by a myeloma specialist, is important. But, this is not always easy due to the large number of combinations, early treatments, and future drugs available.
- Try not to do anything that will close the door on future treatment; be it treatment or side effect management.
- Everyone should get maintenance. For how long or with which drug combo is still in discussion.
- New CAR-T and BCMA target based drugs are here. Here to satay and to be used earlier and earlier in the relapse cycle.
- Quality of life should be personalized and an important informant of treatment goal and measure of outcome.
- MRD negativity depth and duration is important. The earlier in the relapse cycle one is able to achieve that the better.
- Even Dr. Durie, the lead PI for SWOG 777, the study that established three drug combo of PI, ImId and dex, was really intrigued with the PFS benefit that various trials were able to achieve with the use of Dara early in the treatment cycle of myeloma treatment. While the 4 drug jury is still out, we look forward to using MRD guidance to determine who benefits form a 4 vs 3 drug combo.
- But most importantly, myeloma expert, when available, SHOULD be part of the treatment team.
Sharing the Hope,