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Multiple Myeloma Support Group |
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Minutes
- May 10, 2008 Saturday, May 10,
2008 MULTIPLE MYELOMA SUPPORT MEETING Lori announced an
upcoming Conference presented by the Toronto and area MM Support Group. The Patient, Family & Healthcare
Professionals Conference will be held on September, 12 & 13, 2008; at the
Toronto Marriott Airport Hotel. Myeloma
experts will include Joseph R. Mikhael, Nikhil C. Munshi, Donna E. Reece, David
H. Vesole, and guest speakers will be Robert A. Buckman, Richard Beliveau, and
Michael Katz. The dates of this
conference clash with our scheduled support meeting. We have chosen to promote the meeting in Toronto as there will be
very interesting and important information shared. Lori will pass on any information as she receives it and will try
to arrange car pooling where necessary.
Overnight stays are a possibility.
If you are interested in attending, please leave your name and number at
the back. Please note that in supporting the Toronto meeting, our meeting will
be canceled. Lori and Marnie
attended the MM Support Group Leader Retreat in Arizona. Lori shared some information gained from
this retreat. Revlamid should be
approved between the end of this summer and Christmas of this year. If you already
receive Revlamid free of charge, then you will continue to get it at no cost to
you. Groups will be advocating to get
Revlamid covered. There will be a fight
to win coverage just as there was with Velcade. Both oral and IV uses should be
covered when approval is obtained. There will be an
open meeting on May31, 2008 in Mississauga. Anyone interested in attending can
see Steve. Patients are
living with Myeloma now, not necessarily dying from it. There has been a
tremendous amount of “high class” research in the last 5 to 6 months for
Multiple Myeloma. October is
Multiple Myeloma Awareness Month The group is
looking into setting up a table at the Juravinski Cancer Center. There are still people in the area who don’t
know about our Support Group and are facing MM alone. Lori introduced
our guest speaker, Dr. Ann Benger, a
Clinician who sees patients with MM . Topic: Multiple
Myeloma - Where have we been?
Where are we going? 1844 -first patient -Sarah Newbury - 39 year old woman -patient of Dr. Solly -fractures - bone pain and fatigue -problems with urine and bone marrow -treatment - rhubarb pill with an
infusion of orange peel -2nd patient Thomas Alexander McBean -45 year old tradesman -severe chest pain and breast bone
pain - unusual protein in urine - treatment - removal of one pound
of blood - -maintained with leeches -later treatment - steel and quinine 1873 -Dr. Ruzitsy coined Multiple Myeloma 1895 -Dr. Waldenstrom - plasma cell 1928 -recognition of protein in the blood 1929 -Dr. Arinkin developed bone marrow test What is Multiple
Myeloma? Modern Day
Definition - cancer of plasma cells Consequences of
Multiple Myeloma - uncontrolled
growth of one clone of plasma cells - bones - OAF -
dissolves surrounding bone - causes lytic
lesions and fractures - calcium
dissolves out of bone into blood stream Bone Marrow -
crowds out normal blood forming cells -
anemia -
low white count -
low platelets Blood - protein builds up - effects of high protein are many - more water comes in with blood, worsening
anemia - blood cannot equalize - too thick and very hard to pump
causing many side effects - easier to bleed - includes susceptibility to
infections - protein levels are fairly good
makers of how well treatment is working Kidneys - MM proteins can directly damage
kidney cells and lead to Kidney failure -
protein wasting conditions (Nephrotic Syndrome) Treatment 1947 -Urethane -subsequent trial in 1966 comparing
oral Urethane to cherry or cola-flavored syrup showed no improvement in symptoms
or survival with Urethane 1958-1962 - Melphalan -showed a definite response in 50 -
60% of patients -adding Prednisone improved response
rates and increased survival compared to Melphalan alone 1998 -review of many trials comparing newer combinations
of drugs to Melphalan and Prednisone showed some
increase in response rates -no improvement in overall survival Autologous Stem
Cell Transplant in Myeloma -1996 French Myeloma -Intergroup; 200 new patients with MM assigned treatment
with conventional Chemotherapy or Chemotherapy with a
Transplant -response rates were significantly
better in the transplant group - overall, literature shows about a
12 month increase in survival or remission Tandem Transplant -could repeating a transplant
improve the outcome -patients who achieve complete or
very good partials had longest survival -five trials - three report benefit - two report no benefit -definitely no benefit to a second
transplant Allogeneic
Transplant -transplant from a sibling - could
this lead to a cure -results very disappointing -very few people were cured -too toxic Newer Drugs ?? Smarter
treatments instead of stronger drugs Thalidomide 1957 -introduction by a German pharmaceutical
company as a sedative 1960 -sold in more than 40 countries (not USA) -popular both as a sedative and as a
treatment for morning sickness 1961 -first reports of fetal malformations 1997 -Dr. Barlogie noted that Thalidomide has
anti-antigenic properties and wondered that it might be helpful in patients with MM -trials in patients who have
progressed after other treatments have shown 30% response rate (56% if Dexamethasone added) -first new drug active as a single
agent Bortezomib
(Velcade) 2004 -”proteosome inhibitor” -leads to cell death -cancer cells and proliferating
cells are more sensitive than normal -40% previous response rate -52% with Dexamethasone -lasts 12 months on average -funded and available (1 round only) -lots of side effects Lenalidomide (Revlamid) -a newer, hopefully better from of
Thalidomide -2 large trials in relapsed patients
have shown better responses to Revlamid than to high dose of Dexamethasone alone -will likely be released within the
next 6 - 12 months -cost??? - big challenge - $72,000.00 per year Combinations -
Chemotherapy with Newer Agents -Dr. Palumbo - elderly patients,
first line -randomized - M + P M + P + T VAD + Transplant -M+P+T had best response and
survival -Thalidomide + Dexamethasone -Revlamid + Dexamethasone -Velcade + Liposomal Doxorubicin -Velcade + Dexamethasone -Melphalan + Prednisone + Revlamid -Melphalan + Prednisone + Velcade Role of
Maintenance Therapy -after Melphalan + Prednisone :
Interferon -tried, but too many side effects
with little improvements -after transplant : Thalidomide +
Prednisone -possibly better than tandem
transplant, but no studies as of yet Supportive Care -Pamidronate - reduces bone pain and
fractures -how long to continue? -generally two years -any longer could lead to
Osteo-chronosis of the jaw -Kypho-plasty -on spine -inject a cement like substance -can have extreme side effects Question and
answer period. Thanks and
applause for Dr. Benger’s wonderful presentation. Next Meeting -
Saturday, July 12, 2008 Topic - Community Support agencys |