CMG Association: History
Proposal for the constitution of the Czech Myeloma Group
or how we began (January 1995)
The Czech myeloma group was founded on 4/17/1996 as a voluntary association of physicians collaborating in the 4W study, just then started. Here, the original text, created for the needs of the approval of this initiative at the original working place, is brought out without redaction. We therefore ask the reader´s tolerance and indulgence, but this is how we really started.
HISTORY - INTERNET
Basic ideas and conceptions
Czech National Myeloma Group
At the IInd Internal Medicine Clinic of the Faculty Hospital Brno Bohunice, a group of physicians specialized in the treatment of multiple myeloma started to form a myeloma team. The activities of this team were the natural continuation of the systematic work of Assistant physician Z. Adam, which was expended on the treatment of multiple myeloma disease in the previous years, as documented by numerous publications. The Myeloma team was founded out of the necessity to improve the organization of the work and out of the need to react quickly and flexibly to the changes in opinion on the optimal treatment methods for this disease.
After twenty years of stagnation in the process of finding the treatment for multiple myeloma, there have suddenly arisen new possibilities, how to improve the quality of treatment and how to lengthen their life spans. New drugs - bisphosphonates and erythropoetin, improve the quality of life of the patients. New chemotherapeutical methods - several methods for high dosage chemotherapy - increase the number of total remissions from 10%-20% to 40%-50%. This has increased the average life expectancy by 14 months with respect to standard chemotherapy. Despite these outstanding advances, the myeloma is still classified as incurable and relapses - progressions - occur even after 7 years. A large research effort is dedicated to the treatment of the residual disease. The myeloma is an excellent model for all kinds of maintenance therapies, especially when there are highly sensitive methods for the detection of the residual disease.
The programme builds up on the tradition of the treatment of myeloma at the IInd Internal Medicine Clinic, which has reached the world standard in the extent of standard treatment methods, and comprises a large clientele of patients to date. The programme stands on the possibility of bone marrow transplants with the help of peripheral blood cells, a method introduced by Head physician MUDr. Jiří Mayer at the IInd Internal Medicine Clinic in 1995. The mentioned programme fulfils the contemporary world standards for modern transplant methods.
AIMS OF CMG
1. The introduction of the most effective treatment methods for the treatment of multiple myeloma. We want to seek optimal procedures both for transplant and for post-transplant maintenace therapies in newly diagnosed patients. We want to search for the optimal treatment for relapsing patients, who are resistant to common alkylating cytostatics.
2. The introduction of techniques allowing the monitoring of the residual disease in MM patients. The common maintenace therapy for multiple myeloma is interferone-alpha and dexamethazone. New molecular biologic methods are needed for the effectivity monitoring of this expensive treatment, because, at this stage of the illness, the common electrophoretic diagnosis may be unusable. The introduction of such methods is necessary for a quality evaluation of the interferone-alpha maintenance therapy.
3. The search for optimal residual disease treatment of multiple myeloma. If task 2 is succesfuly completed, the selection of newer and probably even more effective treatments may be possible, based on the analysis of existing methods.
4. The creation of a Czech group of specialists collaborating on studies concerning multiple myeloma. The incidence of multiple myeloma in Czech Republic is 7/100000 inhabitants. No Czech team is able to conduct a fully randomized studyonly on its patient data. Nevertheless, there are many questions which can be answered only by such randomized studies. The cooperation is thus essential. The union of the Czech teams by their own spontaneous initiative is highly unlikely. Here, perhaps one of the companies producing drugs used for multiple myeloma (G-CSF or IFN-alpha) might be of some help in accepting the treatment protocol as its own and initiating a Czech study, which is going to ensure the unification of treatment methods and presentation of results both in domestic and foreign literature under the auspices of the Czech Myeloma Group
1. The basic conception, the approval of the plan by the leadership of the clinic.
2. The creation of a team aimed at the issue.
3. To acquaint the other colleagues with the conception and the intentions of the team.
4. The approval of the protocol for the complex procedure in newly diagnosed patients with MM.
5. The determination of financial organizational and personal conditions needed for the work of the team.
6. To establish cooperation with companies and other centers.
1. The activation of the protocol on 1/1/1996 9 (see 4. 1995)
2. The proposal for the protocol for relapsing patients which have already been treated.
3. To draw up a grant aimed at MM & the residual disease, MM & purging
4. Publications and lecturing activities:
- first results
- new methods
in the area of Southern Moravia, targeted at the education of physicians in the contemporary treatment of MM.
5. The creation of programs for the processing of results and the data connected with the treatment of MM.
6. The improvement of the awareness of the patients with myeloma (flyers, the preparation of a brochure).
7. Seminars on MM on a regular basis at the II
nd Internal Medicine clinic, once a month
8. The attainment of funds necessary for the execution of the programme (technical and personal background, diagnostics of the residual disease)
9. The establishment of cooperation in the Czech republic and in the rest of the world.
10. The establishment of substitutability within the team for the treatment of patients with MM.
11. The work on the grant - flowcytometric evaluation of myeloma cells in peripheral blood and bone marrow and the assessment of results and the preparation of the results for publication.
14. The attendance of conferences and the presentation of results.
1. The activation of the protocol targeted at the treatment of the residual disease.
2. Activation of the protocol targeted at the detection of the residual disease.
The key members of the team are
Zdeněk Adam, M.D., Ph.D. (leader)
Roman Hájek, M.D. (manager)
Marta Krejčí, M.D.
Jiří Mayer, M.D.(member)
Assoc. prof. MUDr. J. Vorlíček, M.D., Ph.D. (member)
CMG is a free association, the members of which are those, who cooperate on the study organized by CMG with the right on co-authorship. We implore the close cooperation of "transplantologists" and the laboratory workers (PCR, flowcytometry).
Compiled by: Roman Hájek, Zdenek Adam