The Latest Myeloma News from the American Society of Hematology Meeting

Andrew Schorr:

Okay, I'm going to work backwards here through you, our panel of experts, and just pose this to you first, Dr. Lonial. So, it seems like there's debate in the myeloma area. How big a deal? You look at certain results of trials. You look at how many people had partial remissions, or there's this other term, VGPR, I think very good partial remissions, almost a complete remission. You look at complete remission. You look at how long somebody lived, survival, and the effectiveness of the drugs where they had a response. There are all these different factors you look at. You look at side effects. What is the significance now where we're seeing numbers boosted in some of these trials of CRs or "complete remission." How much weight should that be given versus a very good partial remission?

Dr. Lonial:

Yes, I think it is a confusing issue, and I think it's important to realize that very good partial remission is not some arbitrary, abstract definition. A very good partial remission means that the protein is 90% lower than it was at the time of initial diagnoses, so a 90% reduction is the very good partial remission area, and this actually came to us from the French group, the IFM, that has done a number of large landmark studies in myeloma, and the reason that they use this cutoff is first of all in their experience very good partial remission seems to track similarly to complete remission in terms of long-term outcomes and second because there is so much fluctuation when the protein gets that low in the measurements of these numbers, and so they wanted to take some of that fluctuation out and just set a bar at a certain level, and that became the very good partial remission.

I think that both of them are probably important, and I think what is impressive with our current novel agent-based therapies, whether in the induction setting or in the relapse setting, is that both VGPR, very good partial remission, and complete remission rates are going up dramatically more than they had been before, and I think that that's a great sign because 30 years ago when all we had was alkylating agents, or what I like to call combinations of marginally effective drugs, we didn't get very many CRs, and we didn't get very many VGPRs, and we had to rely on the transplant to get us there. What we may be doing now with these new drugs or new combinations of either novel agents with new drugs or novel agents with chemotherapy agents, we may be able to get to those same benchmarks without necessarily needing a transplant.

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Page last updated on November 22, 2013