UK: 2013 KYOTO IMV conference report by Dr. ESSEX.

I would like to thank the UKMF for supporting my participation in the IMW 2013. I had the opportunity to present my work to the conference in the plenary abstract session and take part of what was a fantastically organised and attended MM conference.

One theme that I picked up on was one of continuous change ‘everything we think we know is continuously changing and needs to be re-assessed’. This quote was made in reference to the heterogeneity of MM and a push towards personalised medicine. There was a debate about risk adapted treatment versus a one size fits all strategy. Many talks looked specifically at the subsets of patients who fail our standard drug regimens and how they should be treated more aggressively. It was proposed that these ‘high risk’ patients should also be taken into account in future clinical trials where patients should be split into standard and high risk.

From a basic science side a talk that I found very interesting was Dr Ghobrial speaking on her work on microRNAs (miRNAs). She described how miRNA profiles can discriminate between molecular subtypes of MM demonstrating the possibility of using miRNAs for subclassification. Where our ears really pricked up was when she talked about the fact that these miRNAs are also differentially expressed in the bone marrow stromal cells (BMSC), which is where our own interests lie. Here she described how they believe that the BMSC are involved in the transfer of genetic information to the MM cell, by the production of exosomes (Roccaro et al, J Clin Invest 2013). A tumour suppressor miR-15a is decreased in the exosomes of the MM BMSC compared to normal and this paper highlights how the BMSC contributes to MM disease progression.

Another area that had much coverage was the restoration of bone in disease and the measurement of bone damage. As patients are living longer, there is a need to restore bone homeostasis, in long term MM treatment. Even when tumour is removed the bone lesions still remain and in some cases are worse. Only one class of drug is available for the treatment of bone disease – bisphosphonates and we have been using these for 20 years. New targets are in the pipeline, Denosumab a reversible inhibitor of RANKL is in phase III testing and inhibitors targeting MIP-1α and BTK have been tested in preclinical models. The importance of treating all patients with bisphosphonates was highlighted even if there is no bone disease at diagnosis. In terms of bone disease imaging, a technique involving the measurement of calcium isotopes in urine and blood is being developed. This enables real-time monitoring of bone metabolism and can provide quantitative information on short-term changes in net bone mineral balance. This technique would enable early detection of bone changes and be of value in monitoring the progression of disease and evaluating which patients are at higher risk of disease progression.

The conference finished with a short film and a talk from the patient association which thanked us for our work and was a reminder of why we must continue our research for better treatments and a greater understanding of the disease.