This year, the International Myeloma Foundation’s (IMF) 6th Annual Asian Myeloma Network (AMN) Summit was held from October 13-16 in Singapore.
The programs for this year included the 2nd AMN Master Class, the 2nd Asian Patient Support Seminar, and the full AMN Summit 2-day Program, with all three held consecutively.
Attendance to these programs was noteworthy: 95 physicians from 8 Asian countries participated in the AMN Master Class; 81 patient-care partner leaders from 7 Asian countries attended the Asian Patient Support Seminar; and 114 myeloma experts from 10 Asian countries participated in the formal AMN Summit. There was great enthusiasm and excitement from the participants as this was the first in-person AMN Summit since the beginning of the COVID-19 pandemic.
Led by Director of the National University Cancer Institute of Singapore Wee Joo Chng, MD (National University Health System—Singapore); Chandramouli Nagarajan, MB BS, MD, MRCP, FRCPath, FRCP (Department of Haematology, Singapore General Hospital—Singapore); and Daryl Tan, MD (Mount Elizabeth Novena Hospital—Singapore), the local Singapore team served as our wonderful host for all the programs.
Joining yours truly was an impressive international faculty: S. Vincent Rajkumar, MD (Mayo Clinic—Rochester, NY); Thomas Martin, MD (University of California San Francisco—San Francisco, CA); and Jean Luc Harousseau, MD (University of Nantes—Nantes, France). Our presence was greatly appreciated by the attendees.
The IMF Team was also in full force with Executive Vice President of Medical Affairs Lisa Paik; Senior Vice President of Global Affairs Daniel Navid; Executive Vice President of Strategic Planning Diane Moran; and the Meetings Planning Team (headed by Senior Director of Strategic Program Management Annabel Reardon) in attendance. All contributed to an extremely well-executed series of meetings and activities.
The 2nd AMN Master Class
For the first time, the AMN Master Class was attended by participants from the Philippines and Vietnam. The stellar local and international faculty covered all major topics, ranging from initial diagnosis to relapse/refractory disease. The goal was to integrate global information into practical guidelines for myeloma care in Asia.
The sobering reality is that comprehensive testing and much-needed access to drugs are not broadly available. In many instances, Standard of Care (SOC) options such as Velcade, Revlimid, and dexamethasone (VRd) or daratumumab plus lenalidomide and dexamethasone (Dara-Rd) in the frontline settings are replaced by back-up options such as bortezomib, cyclophosphamide, and dexamethasone (VCd); bortezomib, thalidomide, and dexamethasone (VTd); or bortezomib, melphalan, and prednisone (VMP).
The availability of Velcade and Revlimid as generics is improving the situation, but daratumumab is mostly out of reach because of rising costs. Apart from that, autologous stem cell transplants (ASCT) are also not consistently available.
There was great excitement about the use of new and emerging immune therapies such as CAR T-cell and Bispecifics (or T-cell Engagers). Unfortunately, there are NO centers for CAR-T therapy outside of China in the Asia-Pacific region. Juan Du, MD,PhD (Changzeng Hospital—Shanghai, China) presented important new data using CAR T-cell therapy in the frontline setting in China. The results are really remarkable during the pandemic, with very high-level MRD negativity achieved.
However, the use of CAR-T therapy outside of trials will be challenging—with an anticipated cost of 1 million RMB/CNY (currently equivalent to US$138,000) which is steep and unaffordable for a majority of Chinese myeloma patients.
Outside of China, it seems that the only reasonable option is to focus on the local manufacture of CAR T-cells for them to become accessible at a manageable cost.
In some centers like Singapore, manufacturing is possible and options for new trials were discussed. In the interim, the hope is that Bispecifics can become available through the AMN Clinical Trial Network.
While keeping the potential future costs of commercial products in mind, fixed duration studies (such as 6 months to one year of therapy) are being proposed to achieve excellent results with minimum costs. These types of reality checks are very important in attempting to establish real-world access to new therapies.
Big Success of Clinical Case Discussions
Structured clinical case discussions are an innovation in Singapore. Each case was presented with data summaries, test results, images, and the like. Because of rich patient information, very precise recommendations and discussions were made possible.
The Master Class participants really appreciated the feedback from true global experts. The discussions focused on very difficult cases, such as high-risk disease (plasma cell leukemia, for example) and came to a realization that there can be substantial value in discussing best options before a medical crisis emerges—a strategy that can be used for the future. A Master Class test provided the opportunity to further discuss learnings from the formal presentations. Overall, it was a very exciting introduction to myeloma expert care for young participants.
2nd Asian Patient Support Seminar
The 2nd Asian Patient Support Seminar was a very important support update for participants from 7 Asian countries. Led by IMF leaders, Dan Navid and Diane Moran, the discussions centered on support requirements and inter-regional cooperation.
Dr. Tan led the discussions on the medical side—reviewing Asian Myeloma Patient Society Requirements and specific needs to further enhance patient support throughout Asia. The patients were thrilled and engaged actively during the in-person interaction.
During the seminar, I met a patient who reminded me of a prior presentation to the Singapore Support Group. That patient is none other than Ravinder Singh Manocha, who wrote the The Art of My Life.
I was amazed to find a chapter on “Dr. Durie’s Recipe for Life and Cancer.” Having never put forward any type of “recipe,” it was astounding to see how a presentation can be interpreted in this fashion. A key element was my response to a question about mental attitude. I strongly supported the notion that a positive mental attitude is part of the recipe needed to achieve best outcomes and can have a beneficial impact on one’s well-being. It was definitely humbling to sense the importance of my perspective to the author.
Meanwhile, the seminar had numerous lively discussions where follow-up projects were identified. Significant advances are expected to happen in 2023.
6th Annual Asian Myeloma Network Summit: Singapore 2022
The summit began with great enthusiasm because of the return to in-person activities, with everyone warmly welcoming the opportunity to physically meet again. The agenda was the usual blend of global and Asian presentations, covering a broad range of topics: Frontline Therapy, Immune Therapy, MRD Assessment, Relapsed Myeloma, and a new one on Imaging Techniques.
The presentations included some updates about the pending commercial rollout of both next-generation flow (NGF) assessment of minimal residual disease (MRD) testing as well as Mass Spectrometry testing, with both expected by mid-2023 to 2024.
Dr. Harousseau discussed the continued difficulties in drug access as well as drug costs, with no clear path forward on how to hurdle these enormous challenges for both physicians and patients in Asia (and in many parts of the world, for that matter).
Keynote Presentation: Screening for MGUS
The formal summit agenda for 2022 began with a new addition—a keynote presentation on screening for monoclonal gammopathy of undetermined significance (MGUS).
Head of Hematology at the University of Iceland and principal investigator for the Black Swan Research Initiative’s® (BSRI) iStopMM (Iceland Screens, Treats, or Prevents Multiple Myeloma) Project Dr. Sigurður Yngvi Kristinsson gave a lecture on “Is Screening the Way to Go?”
The exciting iStopMM Project began in 2017 where over 80,000 Icelandic individuals were screened, and the results are now available. Over 4,000 patients with either MGUS, smoldering multiple myeloma (SMM) or active multiple myeloma were identified and randomized as part of an ongoing trial to assess of early detailed testing and/or early treatment intervention can improve outcomes and perhaps produce a cure for some individuals.
Although the results are very promising with, for example, more-than-expected cases of SMM being identified, it is still too soon to know the magnitude of benefit that can be derived from the screening process. Nonetheless, it is greatly anticipated that screening will be “the way to go” and will end up being the cost-effective approach to early disease management.
This approach will be closely debated upon in the coming months and years, as it may cause a complete paradigm shift in the myeloma field. For now, follow-up information will be presented at the upcoming 64th American Society of Hematology (ASH) Annual Meeting, which will be held in New Orleans in December 2022.
At the 2022 ASH Annual Meeting, the iStopMM Project will be showcasing 10 abstracts (with 4 oral presentations and 6 posters)— a highly anticipated event.
Learning about the iStopMM Project drew positive feedback from the AMN Summit participants and questions were raised about the possibility of doing a similar program in the Asia-Pacific region, possibly in Singapore. The sky’s the limit in terms of what may be learned and achieved.
Working Group Sessions
The Working Group Sessions were, perhaps, the most exciting part of this year’s summit. Summarized by Dr. Chng, it was tremendous to see many projects moving forward to fruition including:
- New clinical trials with one incorporating MRD testing for the first time
- The establishment of the AMN Virtual Tissue and Data Bank with a plethora of new projects becoming feasible, including one on single cell analyses
- Projects for high-risk myeloma, which has been discussed for several years; new projects include identifying features of patients with early relapse and short survival as well as a new treatment trial for those with high-risk disease
- Asian Resource Stratified Imaging Guidelines were introduced for the first time (comprehensive imaging has been a challenge throughout Asia so a structured approach was warmly received)
- Plans for MRD workshops were set in motion to streamline the standardization of MRD testing across the network
As I noted in my closing remarks, “This is an inflection point—a moment when plans in discussion for years are coming to fruition and carrying the AMN programs strongly forward.”
In closing, there are many thanks to share with those who contributed to the great success of the 2022 AMN Summit—an in-person program with a hybrid component which enabled those in China and Japan to attend virtually from studios in Shanghai and Beijing, and from individual sites in Japan.
Looking Forward to the Future
There’s a great sense of invigoration and expectation that the IMF’s Asian Myeloma Network can now dream bigger and aim for more impactful work, as they gain prestige in the global myeloma community. Onwards to 2023 and beyond!
As always, we would like to thank the many loyal sponsors of the AMN programs. Without your contributions, the success of this year’s AMN Summit would not have been possible.