Circulating Tumor Cell As a Biomarker for Outcomes in Myeloma | Luca Bertamini, MD | #ASH24

Good morning, I’m Luca Bertamini.
I’m a hematologist and a researcher.
I work in the myeloma group in Rotterdam, the Netherlands.
Today I would like to talk about circulating tumor cells.

So which is a topic, and I'm going to present, at this ASH in San Diego. Circulating tumor cells that we like to call also in short, CTC, represent myeloma cells that we can find in the peripheral blood. So in a simple blood of patients. They're quite common.

So generally myeloma is a disease of the bones, as we know. But cells can also go into the peripheral blood, and we can find it and track it.

So what we know is that, patients that have more of these cells generally have a worse outcome. There's been a lot of studies in the last year, but still this biomarker, so this risk factor, is not really tested in the clinic. And there's still some work to be done to get this biomarker really used to help stratify patients.

So, what we have studied and what I'm presenting at this ASH, is a substudy of the pursue study, which is a large phase 3 randomized study that compared VRd transplant and our maintenance to the addition of daratumumab. So D-VRd transplant and DR Maintenance and these trials set the new standard of care for patients eligible for transplant.

So, what we wanted to know is if this biomarker, so this risk factor, is helping us identify patients that have a worse outcome. And also in this context of very advanced regimens.

So what we did is we basically tested patients for this biomarker using flow cytometry. So it's a simple method that can be used in general in all hospitals, and is the same method that we used also for minimal residual disease negativity. It’s also very important because it's another prognostic factor that helps us to identify a patient that will do better than others.

So what we found out is that patients that have more of these circulating cells, again, as previously described, also in this context, with the very effective treatment, they still do a bit worse. And what we also noticed is that this is independent of other risk factors.

For example, we know that it's a very important biomarker from myeloma cytogenetics. Like deletion 17p, translocations, and so on. And also, it's independent of other established risk factors such as international staging system and LDH.

And this is really important, of course, because when you want to look and implement a new biomarker, so a new task for patients, we want to be sure that this adds up on what we already test for, that’s right. So it's independent.

So it's, I think, as understanding better what's going to be the prognosis of patients.

And then what we also noticed is that patients receiving daratumumab, so they generally do better either if they have these circulating cells or not. And they generally have better MRD negativity. So better responses and longer progression-free survival.

So we really believe that these biomarkers, as really important, can be easily tested in patients just from their blood and can be done in centers that are also nonacademic and could really help us identifying patients, which potentially would benefit from additional treatment or different treatment approaches.