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International Myeloma FoundationInternational Myeloma FoundationPatient and Family SeminarPatient and Family Seminar
May 5th, 2006
Vienna, Austria
Myeloma for Beginners
Brian G.M. Durie, M.D., ChairmanInternational Myeloma Foundation
Main Features of Myeloma
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Incidence of Multiple Myeloma Around the World
Asia 1-2/100,000West 5-10/100,000
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STRESS FACTORS
Four Major Factors
VIRUSES
RADIATION
CHEMICALS
e.g. IL-6
MYELOMA CELL
DNA DAMAGE
Microenvironment
Causes of Myeloma
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Development of Monoclonal Myeloma
Build up of DNA damagedplasma cells: Myeloma monoclonal population
Plasma Cells
Trigger Factor(s)
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How Patients Present 2006
BONE ISSUES 30%ROUTINE PHYSICAL 25%*ELEVATED urine/serum protein 15%ANEMIA/FATIGUE 15%INFECTION 3%RENAL DYSFUNCTION 2%MISCELLANEOUS 10%
* IMF: Myeloma Interactive 2003/2004/2005/2006
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Initial Testing
BloodComplete blood countsChemistry profileSß2м; AlbuminCRP; LDHSPEP: IFE/IEPQuant. Immunoglobulins
UrineUPEP on 24 hr urine
Bone marrow asp/biopsyX-rays
Skeletal survey
* MRI; PET; CT/PET
* Serum FREELITE
* Cytogenetics/FISH
* Molecular testing: GEP; SNPs; proteomics; RNA/DNA sequencing
Standard Tests Selective Testing
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SPEP/ UPEP and ImmunofixationEssential Data to Track Response
SPEP
UPEP
Serum Immunofixation
Urine Immunofixation
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New Clinical Criteria for Myeloma**
Very Much Dependent Upon Bone Disease Documentation
MGUS PC < 10%; SPIKE < 3.0G/DLSmoldering not MGUS or MM; D/S stage IAMyeloma (MM*) “End Organ Dysfunction,” i.e. 1 or more of:
Calcium elevation (> 10.5G/DL)Renal insufficiency (CREAT > 2mg/DL)Anemia (HB < 10 or 2G < Normal)Bone disease (Lytic or Osteopenic)
*MM is same as Durie/Salmon stage IB plus stage II/III A/B** British J. Haemat. 2003; 121: 749-757
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Assessment of Bones Essential
X-ray: full skeletal surveyCT scan or MRI with gadolinium enhancementWhole body FDG/PET or CT-PETBone densityBone molecular studies, e.g. urinary NTX
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Bone Damage
NORMAL DAMAGED TRABECULAE
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Prognostic Factors for Staging
International Staging System International Staging System ββ22M / S. AlbM / S. Alb
Stage IMedian: 6 years
Low β2M < 3.5* plusS. Albumin** > 3.5 G/DL
Stage IIMedian: 4 years
β2M < 3.5 but low albumin < 3.5 orβ2M : 3.5 – < 5.5
Stage IIIMedian: 2 years
High β2M > 5.5mg/DL
Based upon 10-15 years follow-up* mg/DL** Gm/DL
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International Staging System
Overall Survival by ISSAsia
0%
20%
40%
60%
80%
100%
0 24 48 72 96 120 144 168 192 216Months from initial chemo treatment
ISS Stage IISS Stage IIISS Stage III
Deaths / N131 / 255159 / 240181 / 246
Medianin Months58 (47,64)38 (31,42)24 (19,30)
Overall Survival by ISSEurope
0%
20%
40%
60%
80%
100%
0 24 48 72 96 120 144 168 192 216Months from initial chemo treatment
ISS Stage IISS Stage IIISS Stage III
Deaths / N539 / 1305912 / 1771894 / 1425
Medianin Months71 (65,75)52 (49,55)32 (30,36)
Overall Survival by ISSNorth America
0%
20%
40%
60%
80%
100%
0 24 48 72 96 120 144 168 192 216Months from initial chemo treatment
ISS Stage IISS Stage IIISS Stage III
Deaths / N591 / 747
1012 / 1146943 / 1022
Medianin Months55 (51,60)40 (37,42)26 (24,29)
Asia
Europe North America
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Tracking Test ResultsB2M/ AlbuminType of “M-spike”; blood/ urineAmount of “M-spike”Chromosome 13; [4;14]; otherBone damage or notKidney damage or notDental evaluationMonitor all routine testsTrack M-spikeFollow-up x-rays/ scansRecheck kidney status; creatinine
Baseline
Follow-up
Other
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Serum Free Light Chain Assay
Advantages for MonitoringAdvantages for Monitoring
Allows non-secretory patients to enter trialsCan reduce use of 24-hr urine testingEnables monitoring of patients with normal SPEP or IFEResponse detected earlier than with other assays• Can supplement MRI
Clear Recommendations Required
Mutual Agreement is Very Helpful
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Mental Health
Reduce stressHave confidence in the treatment planExpect remissionSet future plansDevelop realistic HOPE
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To Reduce Stress, Make Changes
Slow down & plan.
Life can be too fast…
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Work with Your Doctor
Keep her/ him informed Enlist cooperationOpenly discuss questions/ concernsSeek the best care feasible
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Take Care of Yourself
ResveratrolKill Myeloma Cells
Promote Healing
Enhance Relaxation
Help Others When You Can
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