As it approached 11 p.m. on our first night in Stockholm, the IMF team started to experience the lighter side of Stockholm: it was not yet dark! There was a rose-colored glow in the clouds to the west as midsummer's day was approaching in a few days.  June 20th was the summer solstice this year, when in the north, there is no night, and Stockholm has only three or four hours of darkness.
Our bodies, coping with jetlag, had mixed reactions to sunrise at 3:30 a.m. Even with blacked-out rooms, it was difficult as multiple meetings with 7 or 8 a.m deadlines unfolded.  But the energy and excitement of the meetings were infectious.  The opportunity to discuss freely the myeloma "hot topics" during the IMWG Summit was greatly appreciated by all.  
The Kyle Lifetime Achievement Award presentation to Prof Gosta Gahrton in the Hall of Mirrors on Tuesday evening, June 11, was elegant and rewarding, especially since almost all the past award recipients were in attendance, reinforcing the significance of the event. (See separate story.)
The 2013 International Myeloma Working Group reports session on Wednesday morning was widely attended by the myeloma researchers who had gathered at the Stockholm Summit from more 29 different countries.  Short- and longer-term plans for myeloma guideline development and research initiatives were presented. Collegial arrangements to address new questions and projects were put in place. There was a definite sense of accomplishment. 
A result of the IMWG's guideline development process is the recent updated recommendations for the treatment of bone disease in multiple myeloma patients.  Also on the horizon is an IMWG report on "New Drugs and Novel Mechanisms of Action in MM" just being submitted for publication.
Immediately following was the debate!  It was a compact session involving myself as moderator plus Drs. Antonio Palumbo, Ola Landgren, and Joe Mikhael.  This webcast, third in the IMWG Conference Series "Making Sense of Treatment," dealt with everything from frontline treatment options to maintenance, second primary malignancies to everyone's perspective of new ideas for the future. As the interactive discussions drew to a close, a seminal question emerged: "If we were going to identify myeloma patients for potential therapy before "CRAB" (clinical) features emerge: what category will this "pre-CRAB" group become?"  The answer from Joe Mikhael of "LOBSTER" brought waves of laughter from the panel and audience and was a fitting place to close as Joe pondered the details of this potential acronym!
As day became night, and night rapidly became day again, the IMF team moved forward to the final event during our week in Stockholm: the International Journalists' Workshop.  This evening event was held at the spectacular Fotografiska, the Swedish Museum of Photography, an old customs house located by the water, restored at great expense by the city of Stockholm.  Reporters from 11 countries as well as patient representatives from 13 countries (from the IMF's Global Patient Summit, which preceded the event) were part of the audience in a room whose walls were illuminated color photographs of Stockholm: "surround pictures" rather than surround sound!  
The panel for the evening was Susie Novis, Aldo del Col (Myeloma Canada), myself, Dr. Paul Richardson (DFCI), and Dr. Xavier Leleu (Lille, France).  The theme for the evening was "the impact of innovation."  I started by illustrating the impact of penicillin in the area of infectious diseases.  From that, I summarized the doubling of myeloma survival (average now more than seven years) with the advent of novel therapies: thalidomide, Velcade, Revlimid, plus the more recent additions.  
Dr. Leleu summarized the amazingly positive results with the new IMiD pomalidomide (Pomalyst), which led to FDA approval early in 2013 and should lead to European (EMEA) approval later this fall.  Dr. Richardson focused upon results with the proteasome inhibitors (Velcade and carfilzomib [Kyprolis]), emphasizing the very encouraging results with Kyprolis, which led to the FDA approval for that agent.  He also reviewed the range of new agents moving forward in drug development, especially Elotuzumab, HDAC inhibitors, and anti-CD38 inhibitor compounds- recently granted special accelerated or "breakthrough" review status by the FDA.
In closing, I presented an overview of the IMF's Black Swan Research Initiative (BSRI).  This extremely exciting new research has led to much discussion.  The details have been summarized in a recent "OncLive" interview.
And so, exhausted, our packed Stockholm schedule came to a close.  Scanning the evening sky, we watched as the sun wended its way to a late evening sunset and very shortly, an early sunrise and our departure.

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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