Myeloma Updates from Dr. Craig Cole

In a recent HealthTree webinar, myeloma specialist Dr. Craig Cole answered patient questions. He discussed early conditions that can develop into myeloma, MRD testing, new treatments, managing side effects, and more. Below are the main takeaways.

Are MGUS and smoldering myeloma treated?

MGUS and smoldering myeloma are precursor conditions of multiple myeloma. 

MGUS usually does not need treatment. The risk of it turning into myeloma is low. Doctors usually monitor MGUS with regular blood tests.

Smoldering myeloma is different. It means more plasma cells are in the bone marrow. However, there are still no symptoms. Some people with smoldering myeloma have a higher risk. They may develop active myeloma sooner. 

Doctors often use the “20-2-20” rule to estimate this risk. This system looks at three factors:

• More than 20% plasma cells in the bone marrow
• M protein level higher than 2
• Light chain ratio higher than 20

Treatment decisions are personal. Some people start treatment early to delay active myeloma. Others choose careful monitoring. This approach is called active surveillance. Treatment may delay myeloma for some people. However, it does not fully prevent it.

“Some patients with smoldering myeloma choose treatment, and others choose active monitoring. Both can be reasonable depending on the situation.” - Dr. Cole

MRD testing may help guide treatment decisions

Minimal residual disease (MRD) testing is important in myeloma care. MRD means very small numbers of myeloma cells remain after treatment. 

New MRD tests are very sensitive. They can find one myeloma cell among millions of normal cells. This helps doctors measure how well the treatment worked. 

Results may guide decisions about maintenance therapy. Maintenance therapy is long-term treatment after the first therapy has worked. Its goal is to keep myeloma under control. 

Researchers are studying long-term MRD-negative patients. This is to see if some may safely stop maintenance therapy after several years. Early results are encouraging, but more research is still needed.

Blood-based MRD testing could make monitoring easier

Most MRD tests require a bone marrow biopsy. Many patients would prefer fewer biopsies. Researchers are studying MRD testing using blood samples.

Some tests look for circulating tumor DNA (ctDNA). These are tiny pieces of cancer DNA in the bloodstream. These tests are still being studied. They may improve monitoring in the future. Blood tests could make long-term monitoring easier. They may also reduce the need for biopsies. 

New myeloma treatments are expanding access

New immune-based therapies are improving results for many people with myeloma. CAR T-cell therapy uses a patient’s own T cells. T cells are immune cells that fight infections and abnormal cells. These cells are changed to target myeloma cells. 

Researchers are studying a newer approach called in vivo CAR-T. This method programs T cells directly inside the body. This approach may remove the need for lab cell engineering. It could make CAR-T easier to access.

Bispecific antibodies are another growing treatment option. These therapies connect T cells directly to myeloma cells. This helps the immune system remove cancer cells.

Access to bispecific antibodies has grown quickly in recent years. More patients can now receive them closer to home. 

Managing side effects and staying healthy

Some immune therapies reduce the number of normal plasma cells. Plasma cells produce antibodies. Antibodies help the body fight infections. Because of this, infection risk can increase.

Doctors often monitor antibody levels during treatment. Some patients receive intravenous immunoglobulin (IVIG). IVIG contains donated antibodies from healthy donors. It helps support the immune system.

Some treatments cause dry mouth or taste changes. Skin changes or weight loss may also occur. Early support can help manage these side effects. Nutrition support and skin care may help.

Staying active may support overall health. Simple walking can help maintain strength. Eating fewer highly processed foods may also support you.

Vaccines and preventive medicines may lower infection risk. You should discuss vaccine schedules with your care team. 

Are we getting closer to a cure for myeloma?

Myeloma is complex and behaves differently for each person. Some people live many years with controlled myeloma. Others may need more treatment options over time.

Staying informed can help you take an active role in your care. Understanding test results and treatment options can help you make decisions with your care team.

The number of available myeloma therapies continues to grow. Response rates are improving. Researchers are improving testing tools. New treatments and clinical trials continue to expand options. These advances are helping more people live longer with controlled myeloma. 

“Are we curing some people with myeloma today? Yes. But you can’t say you’ve cured a disease until you’ve cured everyone. We’re expanding that cure window slowly so it includes more and more patients.” -Dr. Cole

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