After returning from Europe, where Susie and I recently received a joint honorary doctorate from VUB, there was much catching up to do. But when I arrived home from the office, the Wi-Fi was not working. This is a problem because other reception does not work where we live. A tech support person came to the rescue and replaced an old router. Still no luck. We tried a different cable input source. That didn’t work either. The input source, located on the roof, appeared to be okay.  I realized that the cable snaked out from the roof and across a lane behind our house. I opened the back gate and spotted the broken cable dangling. Our IT hero clambered through the branches of a large tree to reconnect our cable. Success! Definitely a “Wi-Fi Warrior”!

These kinds of every-day difficulties and their solutions can tell us a lot about successful problem-solving.

Resilience in the search for a cure

While researchers search for a cure and patients anxiously wait, obstacles can delay project planning and implementation. Myeloma researchers must have healthy reserves of resilience to achieve success.

At the University of Leiden in The Netherlands, for example, we discussed a BSRI immune-monitoring project in collaboration with the University of Salamanca and the University of Iceland. Coordinating the practical details, such as sample collection, processing, and the logistics of expedited delivery, is a time-consuming challenge to overcome.

In Leiden, I also received good news: transplant-ineligible myeloma patients in Europe will now have access to a three-drug regimen as a first treatment.

This is based on the results of the SWOG 0777 trial (phase III trial of Velcade + Revlimid + dexamethasone versus Revlimid + dexamethasone), for which I am the principal investigator.

I discussed this success with Mark Alles, CEO of Celgene Corporation, the company that had supported detailed, long-term follow-up of the trial. This follow-up confirmed the substantial remission and long-survival benefit of using VRd as a first treatment. As you can imagine, we were both enormously pleased. There will now be broad access to VRd across Europe!

This successful outcome required eight years of follow-up study to confirm the long-term value of using triple therapy. Now, the BSRI researchers are moving ahead to find answers to the following questions:

• Why does this therapy not achieve ideal outcomes for all patients?
• What is the basis for resistant disease?
• How can we build on the VRd success to enhance outcomes?

It will take tenacity and patience to answer these questions – and well worth it!

Black Swan projects examine long survival

After visiting Leiden and Brussels, Susie and I visited the University of Heidelberg in Germany. Here, the BSRI myeloma team has been studying patients who have been in remission for as long as 20 years and beyond. Again, tracking down and studying these long survivors takes—you guessed it—resilience. It is complicated to organize the required testing.

We are learning from the Heidelberg researchers that long-term survivors are sometimes MRD negative. And this is the goal of the BSRI “Cure” trials. But about half of the patients had clear residual disease, which was stable over many, many years. Why is that? We will study this question next.

Resilience in making the MRD Endpoint project succeed

I had hoped to have a short vacation after our stop at the University of Heidelberg. But the need for follow-up on a variety of projects continued. A huge data file couldn’t be electronically transferred from the University of Toulouse in France to the Mayo Clinic statistical team in Minnesota. How would we get this data, critical to our MRD Endpoint project, to the Mayo team?

The answer: old-fashioned leg work. An IMF i2TEAMM member travelled to Toulouse to pick up a data drive, then flew to deliver it to me to take back to the U.S. Upon arrival in Los Angeles, another dedicated team member picked up the drive from me and hand-delivered it to the Mayo team in Minnesota. Mission accomplished!

Now we can put together the data package to submit to the FDA. The goal is to receive approval for MRD as a clinical trial endpoint in the assessment of myeloma therapies. True Myeloma Warriors are making such advances possible.

The lesson of Robert the Bruce

In thinking about resilience, tenacity, and success, I am reminded of a story from my childhood in Scotland about Robert the Bruce, who, in 1314, finally freed the Scottish people from the English. Many leaders, like William Wallace (of “Braveheart” fame), had tried and failed against the English. How did Robert the Bruce accomplish this feat?

According to the legend, Robert lay in a freezing cave, in deep despair, watching a small spider try to start its web across two beams above him. Six times the spider tried and failed to connect to the second beam. Robert declared that if the spider made it on its seventh attempt, he would try a seventh time against the dreaded English.

Hanging on for dear life, the little spider finally made it. Inspired by the small creature’s tenacity, Robert rallied the Scots and defeated the English at the battle of Bannockburn (close to my own birthplace) in 1314 to lead Scotland into unprecedented peace and freedom.

Success is rarely easy. Resilience is necessary to persevere and endure over time. In 2019 there is tremendous momentum and energy that will propel both myeloma patient warriors and myeloma research warriors towards the cure.

Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.