Report on the Multiple Myeloma & Related Malignancies Meeting, Bari, Nov 2011
Meeting organisers, Professors Franco Dammacco and Angelo Vacca, assembled an impressive group of speakers for this enjoyable and informative meeting in the southern Italian Adriatic coastal city of Bari. Europe and the US were well represented by familiar key note speakers including Michel Attal, Herve Avet-Loiseau, Jean-Luc Harrouseau, Hartmut Goldschmidt, Michel Cavo, Antonio Palumbo, Pieter Sonneveld, David Roodman and Kenneth Anderson. Unfortunately, only the UK lacked senior representation from the UK myeloma community.
Michel Attal espoused once more the ‘new European emerging paradigm’ for intensive treatment comprising induction, autograft (+/- 2nd autograft), consolidation and maintenance. His other familiar proposition, strongly endorsed by Antonio Palumbo, was that achieving CR is becoming an increasingly feasible and desirable objective providing additional rationale for the use of the newer agents as first line induction therapy. He conceded that the optimal combination regimen for induction therapy was not yet established but did propose that Bortezomib and IMID based combinations may well prove superior. He also con
This meeting delivered a broad curriculum of current myeloma clinical practice and cutting edge new therapeutic strategies giving credence to Dr Anderson prediction that‘myeloma will become a chronic illness with complete responses in a significant fraction’ceded that it is currently unproven whether a second autograft is worthwhile, although in many cases it is clearly feasible. Furthermore, controversy continues as to whether the second autograft should be given early or late ie after relapse and re-induction. The UK Myeloma X trial will provide important evidence in this debate. Maintenance strategies have compared Bortezomib and lenalidomide although the latter agent appears the preferred option. Given these considerations, with the possible exception of the consolidation issue, the UK Myeloma XI Trial appears well designed and likely to address many of these issues.
Kenneth Anderson summarised novel therapies and new targets under development at the Dana Faber Cancer Institute. Key approaches included immunotherapy approaches including elotuzumab, an IgG1 mab against CS1 target, expressed on MM cells and interestingly, up regulated by lenalidomide. His team are also targeting plasmacytoid dendritic cells (pDCs), key promoters of early myeloma cell colonization and expansion. Next generation proteosome inhibitors are in development including agents that target different proteosome components. Carfilzomib warranted a spec
ial mention due to the lack of peripheral neuropathy observed. Oral proteosome inhibitors are also under development and Dr Anderson concluded ‘I strongly believe the future of proteosome inhibitors is oral.’ Another exciting approach under development is to target protein homeostasis using aggresome inhibitors. The aggresome, is an intracellular organelle that forms when there is an accumulation of protein requiring disposal often seen if protein clearance is not fully effected by the proteosome. Hence inhibiting aggresome function is another method of inducing apoptosis. Furt
hermore, normal aggresome function is also mediated via HDAC activity providing a rationale for the use of HDAC inhibitors to disrupt this process.
Dr Andy Chantry
Senior Clinical Lecturer in Haematology/Honorary Consultant in Haematology
University of Sheffield/Sheffield Teaching Hospitals Foundation Trust