International Myeloma Working Group Summit
IMF Chaiperson of the Board Dr. S. Vincent Rajkumar reports from the 2024 IMWG annual meeting, which took place in-person from June 11-12 in Madrid, Spain.
The International Myeloma Working Group (IMWG) is comprised of more than 300 global experts in myeloma research and clinical care. Members of the IMWG conduct collaborative basic, clinical, and translational research to improve outcomes for myeloma patients while providing scientifically validated, critically appraised consensus guidelines that are followed around the world. The work of the IMWG has greatly advanced the understanding of myeloma and its treatments, advancing patient care and outcomes.
The IMWG’s mission is to identify and implement the most promising research to prevent the onset of active disease, to improve treatment, and to achieve a cure. The IMWG emerged from the IMF Scientific Advisory Board, which was established in 1995. The IMWG was assembled by the IMF in 2002, publishing its first consensus guidelines in 2003. The IMF hosted its first IMWG Annual Summit in 2010 in Barcelona, Spain.
Supporting the important work of the IMWG and its members is a critical element of the IMF’s mission to expand collaborative myeloma research and to help educate the myeloma patient community globally. The IMWG Summit is an important annual activity for many of the world’s top myeloma experts who work on imperative projects throughout the year. The IMWG has become the most prestigious organization for myeloma researchers from around the world, and the IMWG Summit is an important annual activity for top myeloma experts who work together to fulfill the patient-centric mission of the IMF.
Every year since 2010, the IMWG Summit has been both a unique and an extraordinary experience. It is different from other medical meetings in general, and from other myeloma meetings in particular. Our collective primary goal is to move the field of myeloma forward for the utmost benefit of patients. To date, the IMWG has published more than 60 consensus guidelines and research reports. These are highly regarded in the field and include fundamental papers such as the diagnostic criteria, response criteria, and staging systems.
The 2024 IMWG Summit was held from June 11–12 in Madrid, Spain. More than 100 of the world’s leading myeloma researchers gathered for intensive brainstorming and planning. I co-chaired the sessions with the IMWG Steering Committee: Drs. Brian Durie, Philippe Moreau, Nikhil Munshi, and Jesús San Miguel.
The IMWG Summit included both a variety of presentations on a multitude of topics and numerous brainstorming discussions. Each presentation was followed by panel discussions and in-depth conversations with other experts in the audience. The major scientific presentations are summarized below.
The first session focused on monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). Dr. Thorvardur Jon Love (University of Iceland) summarized the major findings so far from the Iceland Screens, Treats,or Prevents Multiple Myeloma (iStopMM) population-screening study, which is funded in part by the IMF’s Black Swan Research Initiative® (BSRI®). The iStopMM project has screened approximately 75,000 individuals over the age of 40 in Iceland for presence of MGUS. The iStopMM study seeks to understand whether screening for MGUS, followed by early intervention, can be beneficial to the general population.
Dr. Love presented data on prevalence of MGUS and SMM. He showed data that there was no significant increased risk of MGUS in persons with autoimmune disorders. Early results show screening can indeed detect myeloma at an early stage, but more follow-up is needed to determine if this translates to improvement in outcomes.
Dr. Shaji Kumar provided an update on SMM. He highlighted the various parameters that can be used to identify patients with high-risk SMM (HR SMM). Patients with a 50% risk of progression to myeloma at 2 years are candidates for early intervention and clinical trials. He also reviewed updated results of the CESAR and ASCENT clinical trials, which are pilot efforts to see whether early aggressive therapy in HR SMM patients can be potentially curative. Visit myelomarisk.com to see the risk stratification calculators.
Dr. Daryl Tan (Raffles Hospital, Singapore, pictured left) reviewed challenges that patients around the world face with regard to access to new myeloma treatments. For both regulatory and financial reasons, many new myeloma drugs are not available to patients in most parts of the world. Dr. Tan discussed strategies to expand access and improve affordability.
Dr. Thomas Martin (University of California – San Francisco) discussed the role that real-world studies can have in accelerating progress. Randomized controlled clinical trials are the gold standard for new drug development, but they take a long time to complete and do not address many pressing questions. Real-world database studies can provide answers to many critical questions. Dr. Martin is leading the IMF immunotherapy real-world database initiative.
Dr. Luciano Costa (University of Alabama) reviewed current advances in frontline therapy for myeloma. Multiple studies now indicate that the addition of monoclonal antibodies to frontline therapy improves outcomes in myeloma. For many newly diagnosed patients, the use of quadrupled (4-drug) regimens is increasingly becoming standard of care. Studies show higher rates of minimal residual disease negativity (MRD-negativity) when anti-CD38 monoclonal antibodies are added to the patient’s induction regimen.
Dr. Francesca Gay (University of Torino, Italy) discussed future strategies in frontline therapy, including clinical trials that test immunotherapies with bispecific antibodies and with chimeric antigen receptor (CAR) T-cell therapy. She also discussed approaches to myeloma in a risk-adapted manner, and the incorporation of MRD in therapeutic decision-making. Autologous stem cell transplantation (ASCT) should still be considered in patients who are eligible for transplant.
Dr. Paula Rodríguez Otero (University of Navarra, Spain) and Dr. Ajai Chari (University of California – San Francisco) discussed updated results from clinical trials with bispecific antibodies and with CAR-T cell therapies. Both CAR T-cell therapy and bispecific antibody therapies are already approved in many countries for the treatment of advanced relapsed refractory multiple myeloma (RRMM). These therapies may be moved up to earlier-line treatment in the next few years. They also discussed patient selection and management of side effects, including cytokine release syndrome (CRS), neurotoxicity, and infections. The IMWG recently published guidelines for use of bispecific antibodies and CAR-T in myeloma.
Dr. Paul Richardson (Dana-Farber Cancer Institute, Boston, Massachusetts) reviewed new drugs that are likely to soon become available for the treatment of myeloma. These include iberdomide and mezigdomide, the new and more potent cereblon E3 ligase modulators (CELMoDs) that are currently in clinical development.
Dr. Nikhil Munshi (Dana-Farber Cancer Institute, Boston, Massachusetts, pictured left) reviewed the discussions that took place at a recent U.S. Food and Drug Administration (FDA) meeting organized by the International Myeloma Society (IMS). He indicated that we are working together to see if MRD and novel clinical trial designs can be utilized to bring new myeloma drugs sooner to the clinic.
Dr. Brian Durie (former IMF Chief Scientific Officer, pictured left) reviewed the excellent outcome at a recent FDA Oncologic Drugs Advisory Committee (ODAC) meeting where there was a unanimous recommendation to consider MRD as a surrogate endpoint for accelerated approval in myeloma. For greater detail, please see the article about the ODAC meeting in this edition of Myeloma Today. Committees & Working Groups
The final session of the IMWG Summit featured reports from all of the IMWG Committees. Updates and action plans were presented by committee chairs: the SMM Committee (Drs. Shaji Kumar and María-Victoria Mateos), the Bone Disease Committee (Drs. Evangelos Terpos and Jens Hillengass), the Immune Therapy Committee (Drs. Thomas Martin and Yi Lin), the Quality of Life Committee (Drs. Surbhi Sidana and Sonja Zweegman, pictured left), the Mass Spectrometry Committee (Drs. David Murray and Brian Durie), and the MRD Committee (Drs. Nikhil Munshi and Bruno Paiva).
The 15th Annual IMWG Summit was a unique, highly productive, exemplary experience of collaboration in myeloma research that we have come to expect from its outstanding membership. The IMF is proud to bring together experts from around the world as part of the IMWG.