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Who Knew Feb 28th Was RARE DISEASE DAY?  I Didn't!  We Must COME TOGETHER!

3/6/2017

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I was contacted by Anna Suarez who wanted to start a partnership to help to obtain visibility for rare diseases like myeloma and mesothelioma.  It is often said there is strength in numbers, and unfortunately rare and orphan diseases do not by themselves have the numbers, but together we do.  Below is a case for a unified approach for rare diseases, and the hope that immunotherapy will play a curative role for rare diseases.  Few drugs have been developed for rare diseases because the limited numbers provide no profit potential for drug companies to spend the billions for development, but together we do have the numbers to drive change.  On a micro scale myeloma has accomplished this with the focused, unified, and consolidated approach of the IMF, MMRF, LLS, Myeloma Crowd, researchers, specialists, pharma, and patient advocates.  This resulted in 5 new drugs for Myeloma a rare and orphan disease.  Just think what we could do with 30 million members vs 30,000.



Each year, Rare Disease Day arrives on the last day of February. In the United States, a disease is considered rare if it affects less than 200,000 people. Even though individually these diseases are diagnosed in small number of people, when considered as a whole, the rare disease community includes 30 million Americans. The National Organization for Rare Disorders (NORD) has announced that the theme for this year is research.

Research and Rare Disease

As it currently stands, there are very few FDA approved treatments for rare diseases. In fact of the 7,000 diseases that are considered rare, 95% don’t have approved treatment options. The 5% of diseases that are lucky enough to have approved treatments still face the battle of accessibility because these treatments can be extremely expensive. But before patients can even confront this challenge, they first have to be diagnosed, which remarkably is a major challenge in itself. Many people who are faced with rare diseases not diagnosed properly or even at all.
The Cancer Breakthroughs 2020 seeks to alleviate some of the burden of limited treatment options. The initiative is tasked with effectively ending cancer through intensive study of immunotherapy with an objective to develop a cancer vaccine by the year 2020. Joe Biden announced the project as the “Cancer Moonshot” in 2016 during his time as Vice President, since curing cancer is a goal on par with putting a man on the moon. The initiative is highly collaborative and brings together the people from the “pharma, community and academic oncology, government, and scientific communities.”

The research focus of the program is Immunotherapy, which uses the body’s natural defenses, the immune system, as a basis for fighting cancer. There are a few different methods with this type of treatment: either encouraging the immune system to work harder to destroy the cancerous cells, or introducing additional biological features, like man-made proteins, to improve how the immune system functions. This is referred to as active and passive immunotherapy respectively.

This treatment is already promising for some rare diseases. A drug called Keytruda is currently being reviewed as an immunotherapy measure for several cancers, including multiple myeloma and mesothelioma. Although currently in the clinical trial stage of development, there have been some successful trials for both of these cancers that have scientists excited. Keytruda has already been approved for other cancers, specifically non-small cell lung cancer and head and neck squamous cell carcinoma. Hopefully Keytruda and other immunotherapy drugs will continue to show positive results and eventually become approved treatments. Having widely accessible and viable treatment options would be revolutionary for the rare disease community.

Impact on Patients

What does this mean on a personal level? Participating in clinical trials is one way that new research can directly affect patients. It may mean receiving a life-changing treatment, or at the very least contributing to our overall understanding of immunotherapy. This can be a huge source of pride for patients, and allow them to be part of the larger conversation on immunotherapy.

At an even higher level, this research and the awareness brought about by Rare Disease Day gives patients a reason to hope. It’s incredibly easy to despair when you are faced with a discouraging prognosis, limited treatment options, and very few answers overall. Patients affected by rare diseases are often segregated by their specific disease, which means they often don’t have the same support resources and communities that are available to more widespread conditions. However, on the few occasions when the rare disease community can come together as a whole, patients are reminded that there is a large group of people that are experiencing some of the same struggles. Even though their symptoms may be different, they can relate to each other over the common challenges that are present across the rare disease community.

And of course there’s the added knowledge that even people not directly affected by rare diseases are paying attention on these awareness holidays. Having the nation’s attention shows patients that they have not been forgotten by their fellow citizens. And this can transition into tangible benefits as widespread awareness results in better funding and subsequently better treatments. Nurturing hope for patients that need it is the core of what Rare Disease Day is all about.




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There are lots of reasons to have hope on this year’s Rare Disease Day - share yours in the comments below!


Good luck and may God Bless your RARE DISEASE Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

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CURE High Risk Multiple Myeloma And You CURE All Myeloma!  Dr. Robert Orlowski Of M.D. Anderson Discusses Present And Future High Risk Treatments.

2/12/2017

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Dr. Robert Orlowski of MD Anderson, an internationally known and respected myeloma expert, was the featured speaker on CURE TALKS on February 24th and discussed current and future treatments for high risk Multiple Myeloma.  You can listen to a rebroadcast if you CLICK HERE.
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So why is progress for high risk multiple myeloma so important?  The primary reason is life expectancy of patients with high risk cytogenetic features will live just 2 years on average, and 3 years under the care of a myeloma specialist.  Low Risk patients now live on average 5 years and under the care of a myeloma specialist, to 10 years and more.   About 20% of patients have high risk myeloma,, but many of the 80% of low risk patients will ultimately become high risk in the later phases of their disease.  We are therefore hopeful  a CURE for high risk patients will not only help newly diagnosed high risk patients, but finally have an option when all available drugs become ineffective.  You can find a definition of high risk myeloma if you CLICK HERE!  The high risk definition is a few pages deep in this article.  

Why Dr. Orlowski to explain high risk disease, and to answer your questions?

- Dr. Orlowski is the Director of Myeloma and Professor in the Departments of Lymphoma/Myeloma and Experimental Therapeutics, The University of Texas MD Anderson Cancer Center.(Considered the best Cancer Center in the World) 

- Dr. Orlowski heads up the MD Anderson Cancer Moon Shot to cure high risk multiple myeloma

- He is on the Scientific Advisory Board of the Myeloma Crowd Research Initiative to find and fund the most probable curative clinical trials for high risk myeloma. CLICK HERE to view the projects.

- His program has exceptional survival rates, and his program is on the cutting edge of those clinical trials for new medications and treatments.

- Doctor Orlowski has an uncanny way of presenting some very complex and detailed scientific information in a manner which is understandable to the patient.  


- Early on in the life of myelomasurvival.com, Dr. Orlwoski was named one of the GREAT EIGHT of  myeloma specialists in the World by this web site, and he remains one of my top choices.

Good luck and may God Bless your Cancer Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1


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Some People are Climbing Mountains for Myeloma, I'd Rather Take a BEACH WALK!

1/29/2017

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Myeloma Crowd has a Beach Walk which will be on March 4th 2017 to raise funds for two Clinical Trials which have great potential but do not fit into the normal model for new drug development.  I am not saying this is in any way an indictment of drug companies, because I and most people know without Celgene and Takeda (Revlimid and Velcade)  the life expectancy of myeloma patients seeing a myeloma specialist would not have gone from 3 years to now close to 10 years. In addition, both of these companies have shown compassion and local support to the patients and IMF support groups.   Daratumamab will put another 3 to 5 years on top of that, but what will provide the next leap forward. 

Based on the myeloma crowd research and the opinions of some of the TOP GUNS of myeloma specialists(Dr. Orlowski of MD Anderson, Dr. Ghobrial of Dana Farber, and Dr. Fonseca of Mayo Clinic to name a few)  there are two Clinical Trials which are both immunotherapy treatments which could lead to the next quantum leap forward.  Patients and their families and of course the caregivers have already given $400,000 towards the first target of $500,000 to fund this research.  I have set up a fundraising team called "Alive And Walking for YOU!" and you can become a team member or contribute if you CLICK HERE! You can contribute at my fund raising page if you CLICK HERE!

This is my commitment to you, I have made my team goal of $15000, and if I make this goal I will jump out of an airplane without a parachute!  I hope the person I am skydiving with(tandem) has one though.  In addition, I will match the first $500 that is committed to the team.  in this way, I am backing my words with action.  This I know, if we do not find the next successful clinical trial our myeloma journey will end far too soon. Help me to help to save us all!  For those who want to get a fast track myeloma education you can also sign up for the 3 day Pat Killingworth's Myeloma Survival School if you CLICK HERE.  There are few opportunities like this available. This was a program developed by Pat, a myeloma patient, IMF Support group leader, and author to help to meet the needs of  myeloma patients. 

Good luck and may God Bless your Cancer Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1


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What Is The Fastest Way To Become Your Own Best Myeloma Advocate?  Pat Killingsworth's Myeloma Survival School!

1/18/2017

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Pat Killingsworth, a tireless patient advocate, put together a program to provide a fun, information packed, educational opportunity to help patients and caregivers come up to speed in their myeloma journey.  It is now in its 4th year and will be on March 3-5 in Fernandina Beach, Florida.  You can get the details for the meeting at the Myeloma Crowd web site if you CLICK HERE.
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Last year we had hundreds of participants from all over North America and from all over the world.  Probably the best  way to present the value of this event is to let you know what it meant for a visitor from Sweden.

"Last year round this time I was surfing the Myeloma sites looking for inspiration. I was in a bad place, feeling low and with my blood results showing an increase in my M-Spike, an increase of 26% every 6 weeks. I knew I was heading for my 2nd SCT by the fall of 2016. I was in a bad place because I was not happy with my doctor here in Sweden. I was in horrible pain and not being taken seriously, like he didn't believe Myeloma was the cause of the pain. Just sent me on different tests that showed nothing except it was possible Myeloma related... I then heard about Pat Killingsworth's Myeloma Survival School. A Myeloma patient get together, a place like no other group meeting. It was a weekend where I could get  connect with Myeloma doctors, true Myeloma specialists, Myeloma nurses, Myeloma caregivers, the latest research and pharmaceutical information. This is what I needed the information and inspiration to take back control over my life with Myeloma. I registered even before checking flights and Hotels. Well folks the rest is is all about me surviving my second Stem Cell Transplant and having a record recovery time. Today is day 79 since my High dose chemo, 78 days since my 2nd SCT, 60 days since I was released for hospital. This is all because I came home from Pat’s Myeloma Survival school confident enough to sack my doctor, find a Myeloma Specialist in a Cancer Centre 20 km from where I live and started to understand this terrible disease that is killing so many of us, but most of all to win. I class myself a winner a Myeloma warrior! I have plans in my life, plans to travel to help people and live. Okay I still have myeloma but I'm not scared any more! I am not in the dark! So one of the plans is I will be returning to the 4th Multiple Myeloma Survival School on Friday the 3rd March until Sunday 5th March. I'm hoping to meet lots of fellow Cancer Warriors to tell my and hear their stories. Here's the link to your survival, see you there!
Pat passed away a month before the last get together, his wife and close friends soldiered on not to disappoint people and to carry on Pat’s legacy. Thank you guys, you saved my life…."


Good luck and may God Bless your Cancer Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1


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Multiple Myeloma The Only Answer Until There Is A CURE.

12/23/2016

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Multiple Myeloma SPECIALIST List RESOURCES, Why is it Important to see a Specialist
Dana Holmes·Friday, December 9, 2016

I can offer my opinion from a Smoldering Myeloma patient's perspective as it relates to a Multiple Myeloma Specialist and what/why we recommend in our Smoldering Myeloma Support Group. There are "tiers" of specialists.

An MM specialist is a hematologist and likely also an oncologist who ONLY treats patients with MM. They DO NOT treat any other blood cancers/disorders (Leukemia/Lymphoma) or solid tumor cancers. The top tiered MM specialists are the ones who are conducting and publishing the research and are the Principal Investigators of the clinical trials offered to the MM community. They are also the doctors who are presenting this data/research at their "industry" seminars and conferences. Most are associated with large academic centers and cancer centers. Many are the Directors or Chiefs of their Departments.

A general hematologist will treat ALL BLOOD disorders, including MM. A general oncologist will treat all cancers. Some of these doctors can be both hematologists and oncologists as well.

The overall outcomes for patients who are under the care of MM specialists are greater than for those who remain under the care of local community hematologists and oncologists. We highly recommend seeking at least a consult with an MM specialist and finding a local hematologist and/or oncologist who would be willing to partner with them to cover/monitor your care should you not be able to continue under the direct care of the MM specialist.

If you want to determine if your particular doctor is conducting/publishing research, use this link. https://www.ncbi.nlm.nih.gov/pubmed... Enter your doctors name along with "and Myeloma" in the search tool bar. This will bring up any research he/she has published and which has been peer reviewed.

This will work for any disease. If you want to check your physician's research interest for MM or SMM (as an example) just link his/her name with that disease. You can try to use the term "and MGUS", but you likely will not find much, as MGUS is part of a disease spectrum. Searching by the highest degree of a disease spectrum will likely yield search results. If you don't see anything listed, it is likely he/she is not actively engaged in research for this particular disease. Do a second search and just enter the physican's name. His/her research will be listed, and it will provide insight into their clinical interests.
Does this mean he/she is not a "good/great" doctor? No it does not mean that at all, but it infers your disease is not their primary focus. If they are not the researchers, at the very least, you want someone who attends their "industry" seminars and conferences to insure he/she is up to date on all of the emerging information. How do determine this? You ask them. Ask them what conferences they attend? You have every right to be an informed "consumer" of your healthcare. We all deserve the very best care. Many of us travel to get this level of care, as these types of top specialists are not found in great numbers.

Again, this is my opinion (but it is also opinion of many in the myeloma patient community).

MANY OF OUR GROUP MEMBERS HAVE LISTED THEIR MM SPECIALISTS IN THE COMMENT SECTION OF THE GROUP MEDICAL DISCLAIMER DOCUMENT
https://www.facebook.com/notes/smol...

Our Member's Multiple Myeloma Specialists Listing https://www.facebook.com/notes/1400...

Why Should Myeloma Patients Visit a Specialty Center? - See more at: http://www.patientpower.info/video/...

Multiple Myeloma Specialists and Hospitals or Treatment Centers
http://myelomasurvival.com/myeloma-...

** Please note.. Both of the lists provided in this link from Gary Petersen may contain the name of the Director or Chief of the Myeloma Specialty group only...it may not capture all of the specialists within that group...if you don't find the name of "your" specialist on either of these lists, just try to determine if his/her Director or Chief is listed...this will assure you they are Myeloma/MGUS specialists and associated with the Director or Chief who is listed.

Multiple Myeloma Research Foundation (MMRF) / Multiple Myeloma Research Consortium Member Institutions
http://themmrc.org/about/member-ins...

Multiple Myeloma Research Foundation (MMRF) list of Myeloma specialists by state
http://www.themmrf.org/living-with-...

The International Myeloma Foundation (IMF) / International Myeloma Working Group (IMWG) Members ( Please note, although most members listed are hematologist/oncologists, some may be Radiologists or Metabolic Bone Disorder Specialists, as an example. Best to search their names to find their specialty ) (Also, please note, the IMF has not updated this list, some of these specialists have transferred to other Myeloma centers). http://myeloma.org/IndexPage.action...

Here is another resource to locate MM specialists (it has some outdated info it seems, doesn't seem to have captured some moves/relocations, so be sure to double check the names you may find and want to consult with against some of the other lists or just by googling the specialists name to see where they are practicing now.) http://www.expertscape.com/ex/multi...

Who's Who @ the Mayo Clinic : List of MM Specialistshttp://msmart.org/

Here is a excerpt from a Myeloma Beacon Discussion (April 3, 2014) http://www.myelomabeacon.com/forum/... and a link to Bone Marrow/Stem Cell Transplant Centers in the U.S.

Re: Multiple myeloma centers of excellence by Dr. Edward Libby on Thu Apr 03, 2014 1:31 pm

Hello from gray (but warming up) Seattle,The following link is to US transplant centers that perform allogeneic stem cell transplants. Even though allo transplantation is not the standard transplant option for multiple myeloma I am posting this link because all allo transplant centers perform auto transplants as well. In general at these centers two out of three transplants are autologous transplants and the majority of autologous stem cell transplants are for multiple myeloma. Centers that perform both autologous and allogeneic transplant are going to be larger and busier. With a larger center that does more transplants there is generally going to be more experience and expertise. http://bethematch.org/For-Patients-...

Types of Bone Marrow Transplants
http://www.hopkinsmedicine.org/kimm...

Here is a good search tool to use to find the research interests of your MM specialists (type their name in the toolbar) http://www.ncbi.nlm.nih.gov/pubmed/...

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ASH 2016: A Meeting of the Minds! Myeloma Specialists Come Together in Greater Consensus.

12/22/2016

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Ten years ago, when I was diagnosed, there were few drugs available and no common understanding of what treatment was best for different patients.  Revlimid and Velcade were not approved yet and every myeloma specialist (people who treated a fair number of myeloma patients) could agree on very little.  One transplant vs. two, what drugs to use and in what sequence, and should one drug be used at a time or a combination?

However today I believe “We have come a long way baby!”  The IMF conducted a symposium on  Friday titled “TREATMENT ADVANCES IN MULTIPLE MYELOMA: EXPERT PERSPECTIVES ON TRANSLATING CLINICAL DATA TO PRACTICE.”

The expert  panel  included Dr. Rajkumar, and Dr. Shaji Kumar from Mayo Clinic,  Dr. Philippe Moreau of France, Dr. Jesus San-Miguel (seem to be the character of the bunch), and Dr. Bruno Pavia, both of Spain. The program was moderated by the president of the IMF Dr. Brian Durie.

Case studies were presented and the panel and audience would vote on a number of ways to treat the case.  What became obvious was that the panel consistently gave the same answers, whereas the audience answers were not nearly consistent.

This could lead me to only one conclusion: the myeloma specialist are finally obtaining a consensus opinion on treatment but the general hematologist/oncologist (audience) has not yet reached the same level of congruence.  So one of the most significant takeaways from the three hour symposium was the templates which were presented for both newly diagnosed and relapsed/refractory myeloma.  This template is much like a Cliff Notes version of mSmart the Mayo Clinic template for treatment.  You will note the newly diagnosed and relaspe slides below.

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These slides show a greater consensus view of early treatment and relaspe from some of the most talented myeloma specialists in the world.  Now if we could just get this knowledge to become “common knowledge” then most every myeloma  patient would have a life expectancy twice the current national average.  So it is today, but more important than 10 years ago to find a myeloma specialist to a treatment plan, which may be implements by your local hemotologist/oncologist. 

Dana Holmes has recently provided her logic in a facebook post.  Because it is so well written, I will post it seperately.  She is writing it to her smoldering myeloma facebook group, but I would argue it is even far more critical if you have active myeloma, or are in your second or greater relapse.


Good luck and may God Bless your Cancer Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1
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ASH 2016 – The IMF Gives A Summary Of Outstanding Improvements In Myeloma?

12/9/2016

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I often wonder why there has been such outstanding improvements in the survival and life expectancy for myeloma patients. As is the case with most success in medicine or science, it is the dedicated members of the teams assembled for the task. Would we have been on the moon had it not been for the formation of NASA? You must be able to assemble a team, coordinate their activities, develop goals, instill a team philosophy, and fund the effort. I am convinced the IMF(International Myeloma Foundation), the MMRF(Multiple Myeloma Research Foundation), and MCRI(Myeloma Crowd Research Initiative) are the vessels which have accomplished this feat.

I say this after watching Friday’s IMF meeting titled “TREATMENT ADVANCES IN MULTIPLE MYELOMA: EXPERT PERSPECTIVES ON TRANSLATING CLINICAL DATA TO PRACTICE. You can see the over 3 hour program at the link:

https://www.myeloma.org/videos/ASH-Satellite-Symposium-2016

What I am most impressed with is the level of talent which was on the panel for this presentation. We had Dr. Rajkumar, and Dr. Shaji Kumar from Mayo Clinic, Dr. Philippe Moreau of France, Dr. Jesus San-Miguel(seem to be the character of the bunch), and Dr. Bruno Pavia, both of Spain. This was moderated by the president of the IMF Dr. Brian Durie These myeloma specialists are exceptional, and assembled in the same room to freely provide their knowledge and treatment perspective to a filled conference room.

Some of my key take away were as follows:


  • These doctors left their egos at the door, and worked together as a skilled and talented team.
  • They truly liked each other, and would often help each other explain key points. They actually were having FUN!
  • They looked at real case studies and when the panel answered questions regarding this case, their answers were surprisingly similar. The audience however was not nearly as consistent. The case was discussed by a panel member and Dr. Durie again asked the same question and the audiences answers were now closely aligned with the panel.
  • The European contingency showed a little frustration because they knew some of the answers to the questions which included drugs which are not available in Europe. I think that would drive me nuts!


What this tells me is that the opinions of myeloma specialists are becoming far more congruent. These professionals have always been at the tip of the spear, and were aware of the most recent development; however their treatment philosophies were all over the map. This was mainly the result of inadequate availability of clinical trial data, meta data analysis from the SEER, CIBMTR, or analysis of their own data.


What this also indicates is the audience who consisted of many skilled professionals had not been as well informed as the expert panel. This highlights the continued importance of educational activities which the IMF has historically provided.


The topics and myeloma experts for this symposium were as follows:


Diagnosing MM: When Should Treatment Be Initiated?
S. Vincent Rajkumar, MD

Should We Be Using Risk-Adapted Therapy in Clinical Practice?
Shaji Kumar, MD, and Philippe Moreau, MD

How Should We Use Maintenance for Patients in Clinical Practice?
Bruno Paiva, PhD, and Jesús F. San-Miguel, MD, PhD

How Do You Choose the Best Treatment Regimens for Relapsed/Refractory Disease?
Philippe Moreau, MD

Where Are We Now and Where Are We Going With the Care of Patients With MM?
Brian G.M. Durie, MD, leads the panel discussion


This is an outstanding educational experience for all health care professionals who care for myeloma patients, and for patients and caregivers. For patients and care givers you will get an understanding of when myeloma becomes active, the importance of genetic testing, the new and critical roll or MRD testing, treatment guidelines for the newly diagnosed and relapsed/refractory myeloma patients, and what comes next on the treatment horizon.

The most important takeaway for me is myeloma experts are becoming far more consistent in their views, and now it is a matter of getting this information to the greater myeloma treatment community.   Not every myeloma specialsit is the same, however with the new drugs, and growing mountain of clinical trial and meta data analysis available the treatment philosophies are similar.  I will talk about a few of these subjects in the weeks and months ahead.  Good luck and may you all have an excellent holiday season. 




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The Proof A Myeloma Specialists Experience Improves Myeloma Life Expectancy and Survival Rates!

10/31/2016

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The premise of this web site was that there is a significant difference between the skills of hematology oncology professionals who treat multiple myeloma patients.    The difference shows up in improved life expectancy and survival rates.   Mayo Clinic recently conducted a retrospective study of myeloma centers and split them into those which saw different numbers of new multiple myeloma patients each year.  They evaluated 94,722 patients and classified facilities by number of new myeloma patients treated per year into four categories;  1) less than 3.6 patients, 2) between 3.6 and 6.1 patients, 3) between 6.1 and 10.3 patients, and 4) more than 10.3 patients.  Life expectancy was almost two times as long for locations which had more than 10.3 patients as compared to those with less than 3.6 patients. Even those facilities with over 10 new patients each year showed improvement with increases in patient count.   Compared with facilities treating 10 patients per year, facilities treating 20, 30, and 40 patients per year had approximately 10%, 15%, and 20% lower overall mortality rates.  Jenny Ahlstrom wrote an exceptional article on Myeloma Crowd explaining  this study and I have included it below.

How To Live Longer With Multiple Myeloma by Jenny Ahlstrom


If you’ve got multiple myeloma, the best kept secret to living longer is not a secret any more: It’s having a doctor that sees hundreds of myeloma patients, not handfuls of myeloma patients.

A recent study by the Mayo Clinic showed that people diagnosed with multiple myeloma are more likely to live longer if they are treated at a medical center that sees many patients with this rare blood cancer.

Using the National Cancer Database, they looked at 94,722 myeloma patients diagnosed with myeloma between 2003-2011. They classified the 1,333 facilities in four groups based on the number of patients treated. Shockingly, over 82% of the facilities that treated myeloma patients were non-academic facilities. And most patients (59%) were treated in nonacademic facilities. The average facility only had 6 new patients per year and only 18 facilities out of the 1,333 had more than 50 new patients per year.

When it comes to treating myeloma patients, volume matters. The study shows that multiple myeloma patients greatly benefited from treatment at more experienced centers. For example, patients treated at centers seeing 10 new patients per year had a 20 percent higher risk of death than those treated at centers seeing 40 new patients per year.

“Studies on cancer surgery have shown the more experience the center or practitioner has, the better the outcome,” states study author Ronald Go, M.D., a hematologist and health care delivery researcher at Mayo Clinic. “It is very difficult to be proficient when doctors are seeing only one or two new cases of multiple myeloma per year. We wanted to see if volume matters when it comes to nonsurgical treatment of rare cancers such as multiple myeloma.”

While this is the first study to investigate the volume-outcome relationship in the management of multiple myeloma, patient Gary Petersen has known this for years. Statistics like this spurred him to create a website called www.myelomasurvival.com that compares treatment centers and their outcomes. Gary says:

"When I was diagnosed with multiple myeloma, I searched the internet for the best treatments and their survival rates.  I would do a Google search like “multiple myeloma survival rates,” and I would change it by putting in hospital names like Mayo, Dana Farber, M.D. Anderson, ad infinitum. The only thing that would come up were clinical trials, National Cancer Institute’s (SEER) survival rates, and some rates for Mayo and for UAMS. That was it! Having an operations engineering and business management background, I was shocked that performance based information (survival by hospital) was not available to the myeloma patient community.
A well-respected Senior Vice President of a multibillion dollar company (and my boss) once said, “You cannot manage what you do not measure!” From my operations engineering background, you use measurements to know where you are and to gauge the success of programs and improvements that you initiate. Total quality management has improved products for decades by using measurements to gauge improvement, so why not hospitals and their multiple myeloma programs?
But the real impetus was being in an IMF support group and watching people, my friends, die too soon – some of them which I knew were getting inadequate care. In addition, places like Little Rock were showing survival rates of seven years whereas the National Cancer Institute indicated an average survival of 33 months. I felt compelled to find a way to bridge the gap between the “What is (33 months)” to the “What could be (7 years)”. Yes, I was on a mission, a mission to SAVE LIFE!"


In short, seeing a myeloma doctor that sees hundreds of patients can change your disease trajectory and life expectancy exponentially. For those who don’t live near a myeloma academic center, it is very common for patients to travel to see a specialist who can help direct your care. Then your local cancer center or hospital can implement that plan. This gives you access to the very best talent in myeloma without needing to travel for infusions and frequent checkups.

Take control over your outcomes and see a specialist today!

Good luck and may God Bless your Cancer Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1



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The Future Of Myeloma! The Beginning Of The End Of The Death Sentence!

9/25/2016

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What is the future of myeloma? I believe the future is much brighter!   We know myeloma patients who are found in stage 1 have a survival advantage twice that of a patient found in stage 3.  In addition, a patient who is found at 49 years of age or before has a survival advantage of  twice that of a patient found  when greater than 70 years old.  Finally, if found early at the time of high risk of progression smoldering myeloma, a clinical trial with treatment of Lenalidomide and dexamethasone showed only 5% of patients had died in the treatment group at 7 years, and 45% of the watch and wait group had died.  New trials are in the works (CESAR and ASCENT) designed to cure 50% of the high risk smoldering myeloma patients, and obviously if found before stage 1 will extend the life of those not cured.  One might also expect the devastating effects of CRAB (hypercalcemia, renal impairment, anemia, and bone pain and damage) conditions will be minimized.

So finding myeloma in its earliest stage is the key to improving overall survival, early treatment and myeloma cure!  And how is this done?  The answer may just be in the small country of Iceland.  A new clinical trial called iStopMM may be one of the most important events in modern day myeloma care. As part of the iStopMM study, all 140,000 Icelanders over the age of 40 will have their blood samples tested for the precursor to multiple myeloma, or MGUS (monoclonal gammopathy of undetermined significance), as well as find those who are smoldering or who are active but yet to be diagnosed.  Dr. Sigurdur Kristinsson of the University of Iceland discussed this exciting and groundbreaking study with us on September's Myeloma Cure Talk and you can listen to the rebroadcast if you CLICK HERE.  Below Dr. Kristinsson explains the program, and how it fits into the International Myeloma Foundations new Black Swan Initiatives.  

The most important question to be answered is whether this is a viable and cost effective approach?  Can this program be scaled up to where it is not 140 thousand people tested, but 148.6 million people like it would be in the USA?    I say the answer is a resounding YES!   I truly hate the methodology of ICER where they determine the cost for one additional year of life of a patient.  ICER computes a year of life should not cost more than $50,000 to $100,000 per life year, and each myeloma patient's year is only worth .7 years of that for a person without cancer.  All of the new drugs for myeloma like Kyprolis, Pomalyst, Elotuzumab, Ninlaro,and Daratumumab failed this test and had cost per year of life (QALY - quality adjusted life year) of  between $200,000 to $500,000.

I will not bore you with the detail (which is at the end of the post),  but my calculation would show this program will provide an ICER based cost per QALY of just $16,312 per QALY.  Or if I assume a myeloma patien'ts life has the same value as someone without cancer, the cost per QALY is $11,404.  So as you can see this project would be way below the ICER targeted cost per QALY.  However, because in the beginning all people over 40 would have to be tested in the first year, and thereafter just those who turn 40 need to be tested, I made this a 10 year project life.  After the 10th year the cost per QALY goes way down to just  $3521 per QALY.   So as you can see that even by ICER standards the cost per QALY is OUTSTANDING.  The numbers are big, but the payoff is huge as well.  If you want to go though the minutia of the analysis I have included it at the end of this post. 


Good luck and may God Bless your Cancer Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1










The analysis of cost

Data:

US population - 318.9 million
US population over 40 years of age - 46.6%
Percentage of the population who turns 40 each year - 1.25%
Cost for the light chain and M spike test per patient - $150
Number of myeloma cases each year - 30,330
Current life expectancy of a myeloma patient - 5 years
Average age of a myeloma patient - 69 years
Average life expectancy of an American at age 69 -16 years
If treated early 50% of patients are believed to be cured or live an additional 11 years
If treated early the other 50% will live twice the current average or 5 additional years

10 year project cost

First year cost - 318,900 x .466 x $150                  =    $22,291,050,000
Year 2 thu 10     318,000 x .125 x $150 x 9            =        $ 598,000,000
Total 10 year cost                                                          $27,673,000,000


Life years saved

Cure (30,330 x .5 x 11 x10years)                               =           1,668,150
Double life to 10 years (30,330 x.5 x 5 x 10)              =              758,250
Total 10 life years saved                                                           2,426,400

QALY's   (2,426,400 x .7)                                                          1,696,480

Cost per QALY  ($27,673,000,000/1,696,480)             =            $16,312    
Cost per Life Year ($27.673,000,000/2,426,400)         =            $11,404


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The Rosseta Stone For A Myeloma Cure?   Early Treatment Of High Risk Smoldering Myeloma!

9/18/2016

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PictureDr. San Miquel, Ponce de Leon Family Resemblance?
Dr. Irene Ghobrial of Dana Farber Cancer Institute has said a clinical trial must show an OS(Overall Survival) advantage to justify the treatment of myeloma in the high risk of progression smoldering patient population.  Many trials on the smoldering population had been conducted with no OS advantage, until Dr. San Miguel's group in Spain implemented a trial utilizing LD(Lenalidomide and Dexamethasone) vs. watch and wait(the previous standard of care).  The LD arm  showed a significant survival advantage.  This was the study we all hoped would one day provide the key to improved survival and potentially cure.  This study was the key to improved overall survival and cure and is the equivalent of a myeloma Rosetta Stone.

We recently had the honor of having Dr. Jesus San Miguel, the  Medical Director of the Clínica Universidad de Navarra, Navarra, Spain on the Myeloma Cure Panel.  You can hear this exceptional panel discussion if you CLICK HERE.  Some of the key observations from this broadcast include the following.

The trial was called the QuiRedex trial, and enrolled 119 high risk of progression Smoldering Myeloma patients separated into two groups.  One half of the patients utilized the current standard of care, which is to watch and wait until the myeloma becomes active myeloma before treatment is applied.  The second group was treated with Lenalidomide and Dexemethasone.

The results for the LD group was OUTSTANDING.  The time to progression(TTP) for the watch and wait group was 21 months and 85% of these patients had progressed.  In the LD arm 25% of patients had  progression and the average TTP had not been met.  Overall Survival for the watch and wait group at the 7 year mark was 64%.  In the  LD group 95% of patients are still alive.  So if you are High Risk of Progression Multiple Myeloma (HRSMM) and choose to watch and wait, you are 7.2 times more likely to die than if you chose LD treatment.  A significant and outstanding  improvement for HRSMM.

Smoldering patients fall into three different categories, low risk, intermediate risk and high risk of progression.  There are two major classification methods. The main classification for smoldering myeloma is more than 30 grams per liter of M component  and 10% or more of plasma cells in the bone marrow.  The Spanish group uses multiparametric flow cytometry and  when all the plasma cells are clonal, this is considered high risk. Dr. San Miquel believes there is no need to have one consolidated definition, but can have several individual different measurements all of which show risk of progression of 50% within two years.

For a long time there was no rational for treatment because most of the treatments were not effective.  In addition, we could not distinguish between low, medium, and high risk smoldering myeloma, so all smoldering patients were included in the trials. Now there are ways to determine patients with a high risk of progression to active myeloma.  These patients have between 50% and 80% probability to progress within two years.  These patients will not want to wait for treatment if they will progress in two years.  Like breast caner they need to be treated as early in the disease development(HRSMM) as apposed to waiting for it to metastasize. 

New trials are designed to increase the percentage of patients who achieve a cure.  Cure is defined as being in CR(complete response) for 10 years, or MRD (minimum residual disease) negative for 5 years. There are currently two trials for high risk of progression smoldering myeloma, CESAR and ASCENT which are aggressive treatment approaches but with slightly different drug treatment regimens. The CESAR trial is a Spanish study, utilizes the Kyprolis/Revlimid/dexamethasone regimen. The ASCENT trial is a US study which adds daratumumab. Both use stem cell transplant and maintenance.  The prediction is 50% cure for the patients in both trials. In the LD trial there was little genetic information for most of the participants, however in the CESAR trial patient cytogenetic features will be available and followed. The CESAR trial will include MRD tests after induction, SCT, consolidation, and once each year during maintenance.  The MRD test will be by next generation flow and next generation sequencing.

Even though the LD trial had MRD negative patients, Dr. San Miguel  believes the addition of K(Kyprolis) and SCT(stem cell transplant)  will increase the number of patients who achieve cure.  In addition, he believes new myeloma treatments which include targeted therapies should be part of combination regimen.  Myeloma is not a monogenetic disease, and requires more than a single treatment modality.   Myeloma has a complexity of the clones.

Most of smoldering patients have not developed high risk genetic features as is found  in active myeloma currently.   Even in MGUS,  many of the  genetic features are now present in very small quantities as subclones without the capacity to progress, which  are being controlled by the immune stem cells.  Genetics is not the only explanation of  progression and the immune system is a key part of this.  Progressing from MGUS, smoldering, to active myeloma is not only caused by new genetic  abnormalities but includes  proliferation of one of the clones that was there from the very beginning.  The immune system and immune response is a key component in the progression. Mutations will accumulate with time.  So that is why early treatment is important.

For smoldering patients who are low or intermediate risk, Dr. San Miquel would recommend they delay treatment and watch and wait.  The science will advance quickly.  If high risk he recommends treatment, and patients should consider an open clinical trial for treatment. 

Dr. San Miguel's work is what I believe will be the first step required to make myeloma a disease which is Found Early, Followed to when it becomes HRSMM, and Fought with a treatment regimen with a goal of CURE.  So let's F Myeloma, Find, Follow, and Fight it. 

Good luck and may God Bless your Cancer Journey.   For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1






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