Project Aims to "Bridge the Gap" From Remission to Cure in Multiple Myeloma

Published: Friday, Jun 21, 2013
Dr. Brian G.M. Durie
Brian G.M. Durie, MD

Chairman, International Myeloma Foundation, North Hollywood, CA

When patients respond well to treatment for multiple myeloma, doctors can’t tell them whether they’ve been cured. That news comes 10 years later, after the patients have been monitored carefully for recurrence.

“During that time, you’re constantly watching and waiting for the second shoe to drop,” according to Brian G.M. Durie, MD, chairman and co-founder of the International Myeloma Foundation (IMF).

Through an IMF project, Durie and his colleagues are seeking to remove that long period of uncertainty for such patients. Under the Black Swan Research Initiative, the team plans to develop the first definitive criteria for a myeloma cure, and to set forth treatment plans to achieve those criteria.

The project will involve developing tests sensitive enough to determine whether patients have any myeloma cells left in their bodies following treatment. Those who don’t have such cells would be considered cured, and would know that in the short term. Those who do would be offered different treatments until tests show that their residual cancer cells have been eliminated.

Durie expects the work to be completed within three years.

“We’re ready to bridge the gap from long-term remission to cure, by identifying the best treatments at the best time to achieve the best objective, our objective being a new definition of cure based on a complete eradication of any residual myeloma,” Durie said.

In an interview with OncologyLive, Durie provided details about the Black Swan initiative and how he expects the project to develop.

Why is this project called Black Swan?

Here in the Northern Hemisphere, everybody knew swans were white until 1697, when Willem de Vlamingh sailed up Swan River in Western Australia and found black swans. Based on that, we realized swans could be any color. The idea is that we need to be open to new ideas, to look at things you may have been looking at already, but in a new light.

At the same time, we can learn something from the 2010 edition of The Black Swan: The Impact of the Highly Improbable, a guide to financial investment theory by Nassim Nicholas Taleb. The concept is that you invest 80% of your money in a standard fashion, but 20% in bold new ideas. The caveats are that: (1) you have to be willing to invest in a number of different projects in parallel, with the idea that one will be fruitful, and (2) you have to consider the best advice out there about which projects might pay off. Likewise, in trying to find a cure for myeloma, we need to look at different research projects in parallel and get the best advice possible to come up with likely projects.

Why is this the right time for the Black Swan Research Initiative?

With novel therapies, we see long-term complete remissions in 15% to 20% of our myeloma patients. These patients are getting to low levels of disease where they could have a minimal residual disease (MRD) level of zero. But we don’t have reliable, precise enough testing for MRD. The aim of this project is to come up with tests that are reliable and usable by groups around the world, and that are validated to confirm that they do, indeed, correlate with long-term remission and survival.

Who is conducting the Black Swan research?

A multinational consortium of leading myeloma experts. The consortium is a subset of the International Myeloma Working Group, the research arm of the IMF.

How will this group create tests that are sensitive enough to check for MRD zero?

There are two types of tests that we use on these patients now. One is automated flow cytometry, where you pass blood through a flow cytometer to see if there are any myeloma-like cells in the blood. The other is a test to see, at the molecular level, if there is any myeloma-related DNA in the blood.

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