Yi Shuo Blood New Time and Space Gathering Chinese and foreign forces, talking about multidisciplinary progress, MM International Exchange Conference was grandly held

Multiple myeloma (MM) is a malignant disease in which clonal plasma cells proliferate abnormally, which is highly heterogeneous and has very different prognosis for survival in different patients
.
MM treatment has made great progress in recent years, and there are many explorations for relapsed/refractory and high-risk patient populations
.
On this occasion, the "Yi Shuo Blood New Time and Space - MM International Exchange Conference" was grandly held
on October 29, 2022.
The conference was chaired by Professor Chen Wenming of Beijing Chaoyang Hospital affiliated to Capital Medical University, co-chaired by Professor Bao Li of Beijing Jishuitan Hospital and Professor Zhong Yuping of Qingdao Municipal Hospital, and invited Professor Tadao ISHIDA of Japan Red Cross Medical Center, Professor He Aili of the Second Affiliated Hospital of Xi'an Jiaotong University, and Dr.
Yan Xiaoyan of Peking University Clinical Research Institute to share their features
.
Yimaitong has now compiled the wonderful content as follows for the readers!

At the beginning of the conference, Professor Chen Wenming, chairman of the conference, said in his opening speech that the current MM treatment drugs are emerging in an endless stream, the number of treatment lines is constantly moving forward, and the emergence of CD38 monoclonal antibody provides new treatment options
for MM.
In recent years, Sino-foreign exchanges have been in full swing, and this conference has not only detailed explanations of clinical research progress, but also real-world practice sharing, and looks forward to the sharing and in-depth exchanges
of speakers and discussion experts.

China-chinadialogue discusses the high risks and effectively improves the level of MM treatment

Moderated by Professor Wenming Chen, Professor Tadao ISHIDA shared the treatment strategies
for high-risk MM in Japan.
1q gain/amplification (1q+) is one of the most common chromosomal abnormalities in MM patients, associated with high tumor burden, advanced disease staging, and is considered an independent adverse prognostic factor for overall survival (OS), even in the era of new drugs with proteasome inhibitors and immunomodulators
.
Patients with 1q amplification (≥ 4 copies) had a worse
survival prognosis than those with 1q acquisition (3 copy numbers).
Studies have reported that genes such as CKS1B, PSMD4, MCL1, and ANP32E on chromosome 1q21 are associated
with the malignant phenotype of MM cells.
Subgroup analysis of the ICARIA-MM and IKMA studies showed that patients with 1q+ and soft tissue plasmacytoma could benefit
from the Isatuximab-based three-drug regimen.

In the treatment of MM in Japan, VRd, VCd and VAd regimens are mostly used for newly diagnosed MM patients suitable for transplantation, and a number of clinical studies have also confirmed the good efficacy of D-KRd and Isa-KRd regimens; For newly diagnosed MM patients who are not candidates for transplantation, DRd and DVMP regimens are recommended; For patients with relapsed/refractory MM (RRMM), DKd and Isa-Kd regimens
may be used.
In transplant-friendly patients, early recurrence after autologous hematopoietic stem cell transplantation is associated with
lower survival, regardless of cytogenetic risk.

*V: bortezomib, R: lenalidomide, d: dexamethasone, C: cyclophosphamide, V(VAd): vincristine, A: doxorubicin, D: daratumumab, M: melphalan, P: prednisone, K: carfilzomib, Isa: Isatuximab

In the panel discussion, Professor Tadao ISHIDA exchanged experiences with Professor Yan Xiaojing of the First Affiliated Hospital of China Medical University and Professor Chu Bin of Beijing Jishuitan Hospital, saying that for MM patients with extramedullary lesions, PET examination shows that patients with high SUVmax values, standard chemotherapy may bring some remission, but patients have a higher risk of recurrence, and still need to combine radiotherapy, especially for patients with two high-risk factors such as 1q+ and del17p.
Chemotherapy should be given as precisely as possible to maximize the
patient's benefit.

Taking stock of the progress of RRMM treatment, new therapies are blooming everywhere

Moderated by Prof.
Bao Li, Prof.
Aili Ho shared the latest progress
in RRMM treatment at the 2022 IMS Annual Meeting.
In recent years, MM treatment has progressed rapidly, with the continuous emergence of new drugs and the wide application of new therapies, the survival of RRMM patients has improved, but the overall is still not ideal, and with the increase of the number of treatment lines, the prognosis of patients is worse
.
Patients refractory to lenalidomide who have been treated on prior 1- to 3-line therapy have lower progression-free survival (PFS) and OS, and ISS stage, ECOG performance status, cytogenetic risk, and baseline hemoglobin level are prognostic factors
.

Small molecule drugs are the basic choice for the treatment of patients with early-relapsed MM, and the post-hoc analysis of the OPTIMISMM study (bortezomib dose-adjusted/unadjusted PVd versus Vd), the global pooled analysis of the ASSURE study (IRd), the CC-92480-MM-002 study (Mezigdomide+Vd/Kd), and the single-center retrospective study of patients receiving a seliniso-containing regimen at Levine Cancer Institute, Both showed good antitumor activity and safety of
novel small molecule drugs and different drug combination regimens in patients with RRMM.

*P: pomalidomide, I: Ishazomi

Antibody drugs, especially CD38 monoclonal antibodies, have shown considerable efficacy and safety, and the IKMA study and ICARIA-MM study have shown that Isatuximab-based three-drug combination regimens can significantly prolong patient survival, and have been verified in the French real-world IMAGE study, CD38 monoclonal antibody combination regimens have become a sharp tool
for the treatment of RRMM 。 Bispecific antibodies targeting BCMA/CD3 such as ABBV-383, REGN5458, and Teclistamab have also shown deep remission and controllable safety, which are highly promising
in the treatment of RRMM.

Patients refractory to the backline and refractory to ≥ 3 drugs are still difficult to treat, and new drugs for them are emerging, and new immunotherapies such as antibody conjugate drug Belantamab Mafodotin, chimeric antigen receptor T (CAR-T) cells cilta-cel, ide-cel, etc.
show great potential
.

In the panel discussion, Professor He Aili exchanged experiences with Professor Liu Aichun of Harbin Medical University Cancer Hospital and Professor Zhao Haifeng of Tianjin Medical University Cancer Hospital, saying that for standard risk patients who have achieved complete remission (CR) and negative for minimal residual disease (MRD) after autologous hematopoietic stem cell transplantation, and elderly patients who pursue quality of life improvement as the treatment goal, there may be no need to move forward the number of CAR-T treatment lines.
However, for patients who do not achieve MRD-negative after autologous hematopoietic stem cell transplantation, and patients who do not achieve MRD-negative or obtain CR after premenstrual induction but relapse early, patients who are not suitable for transplantation should consider moving the number of CAR-T therapy lines forward
.

Dive into statistical strategies to help conduct high-quality, real-world research

Moderated by Prof.
Yuping Zhong, Dr.
Yan Xiaoyan shared how to conduct high-quality real-world clinical research
.
Real-world data generally refers to information/data collected from different sources through routine, non-regulatory purposes, including electronic health records, medical product or disease registration information, medical insurance data, etc
.
Real-world evidence is generated
through the analysis of real-world data.
Research that produces real-world evidence is called real-world research
.

Real-world data needs to meet the standardization of data form and the relevance and reliability of data content, retrospective data needs to be sorted out later, and prospective data needs to be unified in format, and because there are many research populations and departments included, such as medical oncology, hepatobiliary surgery, radiotherapy and chemotherapy, etc.
, the basic content of case records of each department needs to be uniform
.

For specific projects, firstly, it is necessary to clarify the unique clinical value of the study, secondly, the high quality of data collection, follow-up time and quality control of key variables (such as event determination, measurement of immune indicators, etc.
), whether the selected samples can represent the entire population that wants to be studied (such as different regions, different treatment methods, different levels of hospitals, etc.
), and what is the value of the data platform (multidisciplinary cooperation) itself.
and whether relevant scientific results have been produced, such as whether the endpoints can be used as surrogate indicators for hard endpoints such as death or disease progression, are also key
to consider and grasp.
On this basis, reasonable missing data processing and robust sensitivity analysis are also points for completing "high-quality" studies
.

In the panel discussion, Dr.
Yan Xiaoyan exchanged views with Professor Liu Aichun, Professor Chu Bin and Professor Zhao Haifeng, saying that the significance of real-world clinical research is the clinical value it shows, and the number of cases is not a key factor
.
In the future, it is expected to better promote the establishment
of a national case database through the standardization of case record writing, the confirmation of patient data rights and the rational application.

summary

At the end of the conference, Professor Chen Wenming, the chairman of the conference, concluded that the conference showed the considerable results of clinical trials, and then sublimated to real-world patient data statistics, and explained in detail the treatment strategies of MM and the development
of high-quality real-world research through Sino-foreign exchanges and interdisciplinary sharing.
The content is rich and rewarding, I hope that all colleagues, especially young doctors, will ponder this repeatedly and move forward firmly!

*Isatuximab has not yet been approved in Chinese mainland

MAT-CN-2227993