In recent years there has been a movement to focus on attempts to detect myeloma early, and determine when to treat to prevent debilitating organ destruction.  The infamous multiple myeloma organ damage is referred to as CRAB (High Calcium, Renal damage, Anemia, and Bone Destruction).   My first thought is CRAB is not descriptive enough and sugar coats the devastating consequences of organ failure.  I prefer a new acronym - BASH! Brain damage, strokes, and blood as thick as mud from high calcium, Anemia which robs the body of the defense against diseases, debilitating fatigue, reduced myeloma fighting capability, unending trips to the ER, and the #1 cause of death in myeloma patients,  Spine and Bone destruction, causing fractures, paralysis, limited mobility, and finally High Creatinine limiting kidney function, leading to dialysis, blood abnormalities, and a shorter life expectancy than myeloma without kidney failure.  It is time to BASH myeloma early before it BASHES the patient.  Currently Stage 1 myeloma patients survive over TWO times longer than Stage 3 patients!

It is for these reasons there is a growing belief if we find myeloma early through detection methods, treat it earlier before the immune system falters and myeloma can mutate and strengthen, life expectancy will improve and we will be able to finally achieve CURE.  Dr. Sigurdur Kristinsson is a Professor of hematology at University of Iceland and at Karolinska University Hospital.  He focuses on the treatment and research of plasma cell diseases,  and heads the iStopMM program where all adults over 40 years of age in Iceland will be tested and followed for progression, and possible early treatment.  

Dr. Kristinnson provided his top 10  myeloma abstracts for #ASH19.  He states, "They are focused on early myeloma, early detection/early intervention. Turned out to be a mix: treatment, imaging, novel methods of detection, progression markers… oral and posters."

Abstract 781 – Curative Strategy (GEM-CESAR) for High-Risk Smoldering Myeloma (SMM): Carfilzomib, Lenalidomide and Dexamethasone (KRd) As Induction Followed By HDT-ASCT, Consolidation with Krd and Maintenance with Rd
Presenter: Maria-Victoria Mateos
Session: 731. Clinical Autologous Transplantation: Results: Autologous Stem Cell Transplantation: Lymphoma and Plasma Cell Disorders
Monday, December 9, 2019: 2:45 PM-4:15 PM
W311ABCD (Orange County Convention Center)
Reason for Selection:
KRd and transplant+KRd cons and Rev/dex maintenance for high-risk smoldering myeloma. Preliminary findings show that 56% of patients are MRd negative after transplant.  

Abstract 573 - Timing the Initiation of Multiple Myeloma
Presenter: Francesco Maura
Session: 651. Myeloma Biology and Pathophysiology, excluding Therapy: Myeloma Clonal Heterogeneity: Therapeutic and Prognostic Implications
Monday, December 9, 2019: 7:00 AM-8:30 AM
W224CDGH (Orange County Convention Center)
Reason for Selection - A glimpse into the early stages of myeloma, identifying the first key drivers for progression of smoldering myeloma to active myeloma. Is this key for early therapy?

Abstract 580 - Phase II Trial of the Combination of Ixazomib, Lenalidomide, and Dexamethasone in High-Risk Smoldering Multiple Myeloma
Presenter: Mark Bustoros, MD
Session: 653. Myeloma: Therapy, excluding Transplantation: Novelty in CAR T in Relapsed/Refractory Multiple Myeloma
Monday, December 9, 2019: 7:00 AM-8:30 AM
Hall D (Orange County Convention Center)
Reason for Selection - A phase II Trial of Ixazomib, Len, dex (an all oral regimen) in high-risk smoldering myeloma. Preliminary findings from first 45 patients show 54.7% in complete response and very good partial response. Interesting early findings but longer follow-up needed.

Abstract 581 - Qip-Mass Spectrometry in High Risk Smoldering Multiple Myeloma Patients Included in the GEM-CESAR Trial: Comparison with Conventional and Minimal Residual Disease IMWG Response Assessment
Presenter: Noemi Puig
Session: 653. Myeloma: Therapy, excluding Transplantation: Novelty in CAR T in Relapsed/Refractory Multiple Myeloma
Monday, December 9, 2019: 7:00 AM-8:30 AM
Hall D (Orange County Convention Center)
Reason for Selection - Gem-Cesar trial using mass spectrometry (QIP-MS) for monitoring response, compared to NGF. Mass-spec is a very exciting novel method of identifying M-spikes. We will surely hear more on Mass-spec in the future - could it replace the SPEP?

Abstract 4333 - Analysis of the Sub-Clonal Structure of Smoldering Myeloma over Time Provides a New Means of Disease Monitoring and Highlights Evolutionary Trajectories Leading to Myeloma
Presenter: Eileen Boyle
Session: 651. Myeloma: Biology and Pathophysiology, excluding Therapy: Poster III
Monday, December 9, 2019: 6:00 PM-8:00 PM
Hall B (Orange County Convention Center)
Reason for Selection-  Mechanisms of progression of smoldering myeloma to active myeloma include the role of events associated with relapse (like MYC translocations and genetic changes.). Could changes in sub-clonal structure be a new tool to monitor smoldering myeloma?

Abstract 1794 - Using Current Clinical Markers to Define High Risk Smoldering Multiple Myeloma: Agree to Disagree
Presenter: Elizabeth Hill
Session: 651. Myeloma: Biology and Pathophysiology, excluding Therapy: Poster I
Saturday, December 7, 2019: 5:30 PM-7:30 PM
Hall B (Orange County Convention Center)
Reason for Selection - How to define high-risk smoldering myeloma. Current risk models are not aligned. Need to add markers of biology?

Abstract 1898 - A Phase II Study of Daratumumab in Patients with High-Risk MGUS and Low-Risk Smoldering Multiple Myeloma: First Report of Efficacy and Safety
Presenter: Omar Nadeem
Session: 653. Myeloma: Therapy, excluding Transplantation: Poster I
Saturday, December 7, 2019: 5:30 PM-7:30 PM
Hall B (Orange County Convention Center)
Reason for Selection - People are treating MGUS now? That we have got to see. And ask questions.

Abstract 3116 - A Multicenter Phase II Single Arm Trial of Isatuximab in Patients with High Risk Smoldering Multiple Myeloma (HRSMM)
Presenter: Elisabet Manasanch
Session: 653. Myeloma: Therapy, excluding Transplantation: Poster II
Sunday, December 8, 2019: 6:00 PM-8:00 PM
Hall B (Orange County Convention Center)
Reason for Selection - A phase II study using isatuximab in high-risk smoldering myeloma of 24 patients. Preliminary findings are that 5% are MRD negative. Extra credit to authors for highlighting quality of life.  

Abstract 3174 - Impact of Previous Cancer Therapy on Outcome of Patients with Multiple Myeloma or Smoldering Disease
Presenter: Fahrettin Covut
Session: 653. Myeloma: Therapy, excluding Transplantation: Poster II
Sunday, December 8, 2019: 6:00 PM-8:00 PM
Hall B (Orange County Convention Center)
Reason for Selection - Previous cancer therapy is not a risk factor for progression from smoldering myeloma to active myeloma. Important negative finding! Sometimes we forget them…

Abstract 3034 - Preliminary Phase 1 Data on the Safety and Efficacy of a Novel PET Radiotracer, 124I-p5+14, for Imaging Systemic Amyloidosis
Presenter: Jonathan Wall
Session: 641. CLL: Biology and Pathophysiology, excluding Therapy: Poster II
Sunday, December 8, 2019: 6:00 PM-8:00 PM
Hall B (Orange County Convention Center)
Reason for Selection - Very preliminary but interesting data on PET/CT with novel injection (called 24I-p5+14) for imaging in amyloidosis. Importance for early detection and monitoring of organ involvement.

Thank You Dr. Kristinsson, I think your efforts with iStopMM are the beginning of the end for the devastating effects of CRAB, and the best road to CURE!