should complete remission, however strictly defined, be the goal for everyone? yes! new york,...
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![Page 1: Should complete remission, however strictly defined, be the goal for everyone? YES! New York, October 23, 2014 Ola Landgren, M.D., Ph.D. Chief, Myeloma](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d705503460f94a53325/html5/thumbnails/1.jpg)
Should complete remission, however strictly defined, be the goal for everyone? YES!
New York, October 23, 2014Ola Landgren, M.D., Ph.D.Chief, Myeloma ServiceMemorial Sloan-Kettering Cancer Center, New Yorkwww.MSKCC.org
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Alternative: be lazy, take it easy
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1 2 3 4 5 6“YES ARGUMENTS”
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1 2 3 4 5 6“YES ARGUMENTS”
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Respect your elders!
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Kapoor et al. J Clin Oncol 2013
Importance of good clinical response
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1 2 3 4 5 6“YES ARGUMENTS”
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Newer myeloma drugs provide better clinical response
Kumar Cancer Treatment Reviews 2010; Korde et al. ASH 2013
CRd
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1 2 3 4 5 6“YES ARGUMENTS”
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Kapoor et al. J Clin Oncol 2013
Clinical response to therapy impacts progression-free survival
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Clinical response to therapy impacts overall survival
Kapoor et al. J Clin Oncol 2013
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1 2 3 4 5 6“YES ARGUMENTS”
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Quality matters
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At diagnosis
Partial response (50% reduction in M protein)
Near complete remission (immunofixation pos only)
Complete remission (immunofixation neg)
1 × 1012
Num
ber o
f mye
lom
a ce
lls
1 × 108
Why stop at CR, when we are not yet done?
CureMRD-
Non-quantitative ASO-PCR of bone marrow
Quantitative ASO-PCR of bone marrow High quality flow cytometry of bone marrowDeep sequencing of bone marrow1 × 104
1 × 106
MRD+
0
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Kapoor et al. J Clin Oncol 2013
Clinical response to therapy impacts progression-free survival
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Clinical response to therapy impacts overall survival
Kapoor et al. J Clin Oncol 2013
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Among CR patients, flow cytometry MRD- impacts survival
Rawstron et al. J Clin Oncol 2013
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Rawstron et al. J Clin Oncol 2013
Myeloma genetics and MRD status: impact on overall survival
Hyperdiploidy, t(11;14), or t(6;14)
Gain(1q), del(1p32),t(4;14), t(14;20), t(14;16), or del(17p)
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1 2 3 4 5 6“YES ARGUMENTS”
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Myeloma is NOT a Polaroid!
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Sustained stringent clinical response to therapy impacts overall survival
Kapoor et al. J Clin Oncol 2013
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1 2 3 4 5 6“YES ARGUMENTS”
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There is already a literature: we are already doing it!
Number of published myeloma MRD studies associated with clinical outcomes
Landgren et al. unpublished data
1
81
1
3
PFS
sCR
Flow
NGS
PET CT
ASO PCR
1
3
1
1
OS
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Summary and Conclusions
• Deeper responses in more patients
• Deeper responses = better survival
• Deeper is better, MRD next step forward
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Thank you for your attention!
Ola Landgren, M.D, Ph.D.Chief, Myeloma Service
Memorial Sloan-Kettering Cancer Center1275 York Avenue, New York, NY 10065, USA
Email: [email protected] Phone: 212-639-5126