ASH Interview Series

Brian G.M. Durie, MD, Robert J. Kreitman, MD, and Francis J. Giles, MD
Published: Tuesday, May 18, 2010
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The annual American Society of Hematology (ASH) meeting takes place each December and draws thousands of hematologists from around the world. Many studies presented at ASH in the past have changed care for patients with hematologic malignancies. We interviewed three experts who presented data at the most recent ASH meeting about advances in care for multiple myeloma, chronic myeloid leukemia, and hairy cell leukemia.

Brian G.M. Durie, MD

At the 2009 51st American Society of Hematology Annual Meeting and Exposition in New Orleans, Louisiana, in December, Oncology & Biotech News spoke with Brian G.M. Durie, MD, medical director and co-founder of the International Myeloma Foundation (IMF). Durie is also an expert in multiple myeloma and a pioneer in treating blood cancers and chairs three major research groups: the Myeloma Network for Aptium Oncology, the International Myeloma Working Group, and the Myeloma Committee of the Southwest Oncology Group (SWOG).

OBTN: How does IMF work to increase awareness of multiple myeloma in the broader community?

DURIE: IMF is a nonprofit entity based in California and has been in existence now for approximately 20 years and has many tools in place now to raise awareness about myeloma. By telephone and through the Website (, we make a lot of information available and alleviate a lot of instant fears that patients might have when they first hear the word myeloma, which they most likely would never have heard of before.

If the word myeloma comes up in the diagnostic discussions for a patient, in this electronic age, patients can log myeloma into Google or any one of the search tools and go straight to our Website or call our hotline. We have four hotline staffers in the United States who are well informed about myeloma and can answer questions directly. They can also send published materials or direct people back to the Website to download informational materials. For example, we have booklets about understanding myeloma, understanding anemia, and understanding different drugs that are used to treat myeloma.

One arm of the IMF is the research arm, and one part of that is the International Myeloma Working Group, which is a collaboration of 120 experts form the different major centers working on myeloma around the world. We have worked very hard to take advantage of resources throughout the global myeloma community. The experts in our Working Group provide input from all around the world so that we have appropriate upto- date information. I think that IMF is a tremendous resource.

How is multiple myeloma diagnosed?

We rely these days on the presence or absence of four important features: elevation of calcium, the presence or absence of renal problems, the presence or absence of anemia, and the presence or absence of bone disease. This leads to the acronym CRAB—calcium, renal, anemia, and bone.

The testing for each of those needs to be implemented and the test evaluated to see if there is a problem in any one of those areas, and then seek appropriate consultation about how to start with the treatment paradigm. It’s important to realize that that is the strategy in North America and most of the European nations.

What are some of the challenges in diagnosing multiple myeloma?

There are several challenges in diagnosing multiple myeloma. On the one side, we don’t want to over diagnose and start treatment too soon. But, on the other hand, we want to diagnose and start treatment for those patients who might have serious complications evolving.

Diagnosis can come about through routine testing in which the serum protein or the urine protein level is found to be elevated. The challenge there is to follow through and reach a correct diagnosis. In the one case, it could be a monoclonal gammopathy of undetermined significance, a benign phase of the disease, or there could be truly active multiple myeloma that requires treatment. There needs to be knowledge of what’s necessary to make the diagnosis.

In other parts of the world, such as Latin America and many parts of Asia, this type of routine testing [seen in North America and Europe] has not been carried out…and we find the diagnosis is really, really delayed. When we look at the staging of the disease in Latin America, for example— specifically Brazil—85% to 90% of the patients have stage III disease with high blood calcium and many, many problems. And so the challenges are diverse as we look at this around the world.

How has the care of patients with multiple myeloma and their prognosis changed over the past decade?

This has perhaps been the most exciting thing about myeloma therapy, in that we have seen the impact of the novel agents. We have three new drugs that have become available for myeloma in the past decade that many of the investigators refer to as “The Three Musketeers”: thalidomide, Velcade, and Revlimid. These three drugs have really changed the landscape in myeloma therapy.

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