The 16th International Myeloma Workshop was held in New Delhi, India March 1-4. This gathering of those interested in myeloma from around the world was definitely a global amalgam. The format included multiple short presentations to encompass the full range of scientific and clinical topics. For those who participated in last December’s annual meeting of the American Society of Hematology (ASH) there was not much new, but for those looking for expert summaries, this was the spot to be. This year’s Waldenstrom Award recipient was Prof. Thanos Dimopoulos (University of Athens), a truly deserving winner.

For me, the high points of the IMW meeting were the special lectures by Dr. Vincent Rajkumar (Mayo Clinic) and Dr. Nikhil Munshi (Dana-Farber Cancer Institute). Dr. Rajkumar addressed “Critical Questions for the Next Decade” for the myeloma community, including how to identify and integrate new therapies into the best treatment paradigms for all the “multiple types” of myeloma. Really, an excellent overview for all. A bit later, Dr. Munshi looked at the future—and he chose to look a few hundred years into the future using a modified “Star Wars” video to lead off. A 78-year-old woman with myeloma and renal failure made an immediate recovery with a single capsule! Then, on a more serious note, he touched on possible blood testing, drug sensitivity analyses to select best therapies, and other novel approaches for diagnosis and treatment. However, it is not clear when the “cure-all” magic capsules will be available.

Challenge of limited treatment resources

There were also Consensus Guideline presentations on Diagnosis (Dr. Shaji Kumar, Mayo Clinic); High Risk (Dr. Sagar Lonial, Winship Cancer Center); and Infection & Vaccinations (Dr. Noopur Raje, Massachusetts General Hospital). These very comprehensive reviews will be moving forward soon in the form of new IMWG Guidelines. An impactful session for me included three presentations about managing myeloma with limited resources. Although this is a topic which really applies everywhere these days, this session focused on India (Dr. Lalit Kumar, All India Institute of Medical Sciences); China (Dr. Wenming Chen, Beijing Chaoyang Hospital); and Latin America (Dr. Vania Hungria, Clinica Médica São Germano). 

Each speaker focused on the impact of access to diagnostics and new therapies. The clear implication was that lack of early or proper diagnosis and severe lack of access to most of the newer therapies is substantially reducing outcomes—a serious impact for each and every patient.

Future faces of myeloma research

In the same session, I was honored and privileged to co-chair with Prof. Jesús San Miguel (University of Navarra) the segment in which the Young Investigator Awards were given. I introduced Dr. Bart Barlogie (Mount Sinai), who bestowed his eponymous Young Investigator Award on Dr. Giovanni Palladini (University of Pavia). Dr. Palladini is the Lead Investigator in Prof. Giampaolo Merlini's Amyloidosis Unit at the University of Pavia. Dr. Palladini was unable to attend, but Prof. Merlini gave an elegant presentation of Dr. Palladini's significant accomplishments in the development of better therapies for patients with amyloidosis.

Dr. San Miguel then introduced Dr. Kenneth Anderson (Dana-Farber Cancer Institute), who gave his newly established Young Investigator Award to Dr. Irene Ghobrial, also of the Dana-Farber Cancer Institute. Dr. Ghobrial delivered an eloquent acceptance speech summarizing her accomplishments and describing future research plans.

Juxtaposition of old and new

This brought to a close an amazing scientific and social meeting in New Delhi, which included a visit to the Taj Mahal for many faculty, and incredible evening events in true Indian traditions. We learned a lot and experienced much about the current spirit of India—a vibrant culture moving forward aggressively in this new century. We also saw the strength of many traditions which continue to influence daily life, such as the “Holy Cow” walking the streets, manifesting its sacred status for all to see. This sacred status emerged when cows were legal currency (before coinage), and were used to pay taxes and as a dowry at weddings.  Cow milk is an important source of nutrition here and cow dung patties are preserved to provide fuel for fire.

Within Hindu traditions, the cow has truly magical significance. But I wondered why, in 2017, do the cows like to hang around streets with busy traffic? It turns out that traffic fumes get rid of flies—the bane of a cow's existence—and some suggest the cows may even get high on the fumes. Nonetheless, the respect for all animals leads to a bizarre menagerie at the roadsides, with cows mingling with goats, camels, dogs, pigs, monkeys, and more. Not quite the local US mall. But there ARE amazing and huge malls here, and on the outskirts of Delhi is a massive “Cybercity.” This is the dichotomy of India today—the ancient traditions retained and the modern tech world progressing at the speed of light, side by side.

The bottom line

Are there any conclusions which can be drawn from the knowledge shared at the IMW for myeloma patients in India and elsewhere outside the US?

As already noted above, medical care is really caught in the middle. Not enough resources are available, and therapies which are desperately needed are not available or are way too expensive. The IMF and the International Myeloma Working Group (IMWG) members are absolutely committed to helping. In New Delhi, Prof. Jean-Luc Harousseau gave an excellent summary of the current situation, reinforced by the presentations from India, Latin America, and the Asia-Pacific region. The issues will be addressed at the upcoming IMWG Summit in Madrid in June.

The IMW in New Delhi was a great venue to bring together those interested in myeloma to learn and understand the challenges ahead. 

Image of Dr. Brian G.M. DurieDr. 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®.

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