The 2018 Myeloma Knowledge Exchange

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Published: 4 May 2018
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Prof Heinz Ludwig - Wilhelminenspital, Center for Oncology and Hematology, Vienna, Austria

Prof Ludwig talks to ecancer about the program and mission of this years Myeloma Knowledge Exchange meeting in Vienna.

He discusses the topics to be covered in the meeting, as well as the importance and history.

The meeting will have discussions and workshops, where patient cases are presented, studied and action planned.

ecancer's filming has been kindly supported by Amgen through the ECMS Foundation. ecancer is editorially independent and there is no influence over content.

The MyKE meeting aims to improve the skills and expertise of myeloma physicians. It brings a lot of specialists so there are many specialists discussing about myeloma related issues when it comes to complications, for instance heart complications, neurological complications, renal complications and also infections. So the idea is to improve the skills of the participants to learn from each other in order to enhance and improve the management of patients with myeloma, not only using the best possible therapies, myeloma therapies, but also applying optimal supportive care, palliative care, for those patients because that matters. Improving quality of care improves quality of life but, more than that, it improves overall survival.

What is unique about the MyKE meeting?

The meetings are different to many other meetings because they are hands-on meetings. So patient cases will be discussed together in small groups with experts and there will be ample interaction between participants and the presenters, case presenters. So you have a different type of experience here because as a participant and as a member of the panel you are really involved and you are talking about real-life cases. You learn from other people here how they would manage this, what are their considerations. So it is not the usual format where you have lectures in big lecture halls; it’s rather more individual special interaction between people with expertise and knowledge and exchange of ideas.

What are you presenting at MyKE?

I have an important topic to discuss, namely infections – prevention and management of infections. 20% of all myeloma patients die because of infections. Actually within the first 3-4 months 20% of patients die because of non-manageable infection so it’s of utmost importance to do everything to prevent these complications and if complications occur to manage them properly. I think there is room for improvement. Of course my topic starts from prevention, namely vaccination, antiviral and antibiotic treatment as preventive measures through to diagnostic measures and management of infections when they occur. So by improving the quality of care we will improve the outcome of our patients. When you look at the outcome survival curves which have been improved during the years, it’s not only due to the introduction of novel active regimens, it’s also because patients now are treated in specialised centres where they have a group of caregivers who have extremely detailed knowledge about all the complications which may occur and how to prevent them and how to manage them.

How does the future look for myeloma treatment and prevention?

The future of myeloma treatment is of course difficult to predict but what is clear is that it’s like a bandwagon effect. So there have been new treatments which have been introduced during the last five years and they have impacted on outcome, on quality of response, on progression free survival, overall survival, quality of life. So there is an enormous improvement going on but there is still a fraction of patients which are very difficult to treat. But the treatment will change; now it is clear that we will have a lymphoma-type treatment, we have it already in relapsed refractory patients, where we use conventional anti-myeloma therapy plus immunotherapy and antibody. We will have CAR T-cells, we will have CAR NK-cells, we will have other cellular therapies, we will have bispecific antibodies, antibodies which are conjugated to toxins. In the near future we still need to use the best treatments of each category together in order to obtain the best possible result. This probably means an over-treatment of very good risk patients but at this point of time the predictive factors are not good enough for selection of specific therapies. In my opinion, if the patient is fit he should receive the best possible initial therapy which is available. But in the future we will learn to select patients depending on their molecular constitution, what treatment might be best for them and we may be able to de-escalate treatment in quite a number of patients. But at this point of time we should give the best to everybody if he is able to tolerate it.

Any take-home message?

Nowadays it is fascinating to be part of these developments, to see how things evolve, how our understanding of the disease improves and what new treatments are available. But also to learn how important it is to interact with our patients, with our clients, in the best possible ways. So we have different means which we all should use in order to achieve the best possible treatment for an individual patient. So the patient looks for caregivers who are very well informed, who have expertise, who are straightforward and who have a keen interest to support them also in terms of humanistic support. So if this is all provided to an individual patient then that is the best that we can do at this point of time.