The 15th Annual IMWG Summit was held from June 10-12, 2024 in Madrid, Spain.

The agenda for this year’s IMWG Summit set the stage for the emergence of new platforms—paving a way to plan forward, improve outcomes, and achieve a cure.

From early diagnosis to managing difficult-to-treat relapsing disease, thought leaders covered everything and weighed in, with new concepts and suggestions.

The iStopMM Project


Day 1 began with an update from the groundbreaking iStopMM (Iceland Screens, Treats, or Prevents Multiple Myeloma) Project in Iceland. A key goal is to determine if screening for the presence of monoclonal gammopathy of undetermined significance (MGUS) can be broadly recommended.

A recent observation that patients diagnosed with active myeloma after initial screening have many fewer CRAB features (or symptoms of myeloma) supports the notion that screening provides value to patients, as well as value from a health economic standpoint, with fewer tests and ancillary therapies being required. 

A new observation that links MGUS to increasing levels of obesity also provides an opportunity for preventive intervention.

Rethinking High-Risk Smoldering Multiple Myeloma (HR SMM)


An update on MGUS and SMM focused on new and better criteria for HR SMM.

A Dynamic Model was presented indicating that changes at 6 months can be used to better predict the likelihood of progression to active myeloma. This can assist in decision-making related to potential interventions, including gentler preventative measures versus more aggressive curative approaches.



Global Access to Care


This new topic for the Summit focused on the continued and increasing costs of novel therapies and the predominant lack of access to them around the globe, which is a huge challenge.

A majority of patients around the globe do not have access to standard of care (SOC) treatments such as triplet VRd or Dara Rd (MAIA trial regimen) in the frontline setting.

In the relapse setting, most of the exciting immune therapies are either unavailable and/or unaffordable. Much work needs to be done for myeloma patients to gain access to these immune therapies.

Even with wonderful results being achieved with Quadruplets [Dara (PERSEUS Trial) or Isa-VRd (IMROZ Trial)] most patients are left disappointed and frustrated. Knowledge needs to be enhanced with true access.

Immune Therapies


There were extensive discussions about all the amazing new option— including CAR T cells, bispecifics and beyond.
 
With response rates reaching almost 100 percent (even in the relapse setting), this is definitely a whole new era in myeloma therapy. The high levels of efficacy with excellent outcomes must be balanced against the risks of significant toxicities, both in the short- and long-term.
 
Such things as serious infections with ongoing bispecific administration (such as anti-BCMA teclistamab) and  Cytokine Release Syndrome (CRS), ICANS (neurotoxicities) plus delayed neurotoxicities with CAR T therapies must all be considered.
 
Appropriate supportive care plus adjustments in doses and schedules must also be carefully considered. Real-world experiences can guide decision-making.
 
Consensus guidelines and recommendations from the IMWG Immunotherapy Committee on management and response assessment of CAR T therapy in clinical practice for relapsed/refractory myeloma were recently published in The Lancet Oncology.
 
The recently established IMF Immune Therapy Registry will identify best sequences in new immune therapy options and will help optimize both response outcomes and ongoing Quality of Life (QoL). 

ODAC Unanimous Favorable Vote for MRD as an Early Endpoint for MM Clinical Trials 
 

There was considerable interest in the unanimous vote (12-0) made by the Oncologic Drugs Advisory Committee (ODAC) committee members, favoring MRD as an early endpoint in MM clinical trials. The ODAC advisory meeting took place on April 12, 2024.
 
Details were presented and discussed, in particular, the composite CR plus MRD at 10^-5 endpoint accepted for Newly Diagnosed (NDMM) transplant eligible and ineligible patients, as well as those with relapse/refractory disease (RRMM).
 
The accepted early endpoints were at 9 and 12 months from start of treatment. The ODAC approval has now opened the way for productive discussions with the U.S. Food and Drug Administration (FDA) to establish details for incorporating MRD testing as an early endpoint into ongoing and upcoming trials.


The bar is now set much higher as new agents move through the approval process.



The 2024 IMWG Summit Awards Ceremony 


Day 1 ended with the annual IMWG Awards Ceremony as the highlight of the evening.
 
There was great support and recognition for both 2024 Brian G.M. Durie Outstanding Achievement Awardee Prof. Francesca Gay, MD, PhD, and 2024 Robert A. Kyle Lifetime Achievement Awardee Shaji K. Kumar, MD.
 
The remarkable evening kicked off with a usual performance by The Myeloma Cells—the famed musical group of the IMWG.
 
Led by IMF Chairperson of the Board Dr. S. Vincent Rajkumar and Dr. Philippe Moreau (University of Nantes—Nantes, France), the group is wildly popular and performed during the roast of Drs. Gay and Kumar. Everyone had fun and greatly enjoyed the music.
 
This was then followed by presentations of wonderful videos and career summaries of the awardees, made by Prof. Mario Boccadoro—IMF Board Member, Hematology Head of the Oncology Division at the University of Torino, and Founder of the Italian Myeloma Study Group.
 
The awards ceremony became a true celebration of the achievements of the myeloma community. 



Working Committees


The Summit concluded with Working Committee reports and open discussions about the future. Each group had many active projects.
 
The Quality of Life (QoL) Committee, a newly formed group headed by Drs. Surbhi Sidana (Stanford University School of Medicine—Stanford, CA) and Dr. Sonja Zweegman (Amsterdam University Medical Center—Netherlands), introduced their initial plans.
 
Many applauded these new planned efforts to have QoL as a focus. Other groups summarized their range of ongoing and new planned projects, with great expectations for outcomes in 2024-2025.

In Closing

The 2024 IMWG Summit in Madrid, Spain was a huge success.

Innovative approaches are allowing us to chart our way forward into an era of highly effective therapies and realistic expectations of cure for subsets of patients.

Optimism was high, and we all look forward to next year’s IMWG Summit in Milan.