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IBC 2024: Longer Life with Myeloma Uncovers New Blood Disorder
Posted: Mar 28, 2024
IBC 2024: Longer Life with Myeloma Uncovers New Blood Disorder image

Many myeloma patients are living longer than ever, which is a great blessing. However, as patients live longer with multiple myeloma, they are prone to developing additional blood conditions like Clonal Hematopoiesis (CH).

CH happens when a cell that can develop into different types of blood cells (called a hematopoietic stem cell) begins making cells with the same genetic mutation. Many people with CH may never have any symptoms, but they are more likely to develop other blood cancers, such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). People with CH are also at a higher risk for cardiovascular problems, like heart attacks.

CH is determined by genetic testing of the blood in a test called Variant Allele Frequency (VAF) which can measure the presence and quantity of clonal hematopoiesis. 

At the recent Intercepting Blood Cancers Workshop in Lisbon, Portugal, Adam Sperling, MD of Dana Farber Cancer Institute, discussed clonal hematopoiesis (CH) and its relationship with multiple myeloma. CH occurs as we age, and patients with it have shorter overall survival. In addition to increasing the risk of MDS and AML, it can also be associated with other inflammatory diseases. 

CH is actually quite common in myeloma patients, being seen in 14-21% of patients. In the MMRF's CoMMpass study, CH was detected in 10% of participating patients. CH is more common in people who were exposed to radiation or platinum-based chemotherapy.

When considering other widely used myeloma treatments, they found that patients who received thalidomide had more occurrences of the TP53 mutation with CH. Lenalidomide, but not pomalidomide, is also associated with a higher frequency of TP53 mutations in patients with CH. CH can also be found in patients receiving CAR T-cell therapies, with 76% of patients having greater than .004 CH and 48% of patients having greater than .02 VAF.

The CH mutation can be found in T cells in all types of blood cancers. Dr. Sperling said that because myeloma patients are living longer and blood genetic testing has advanced, it is now possible to better detect and monitor this mutation in patients. 

The experts said that it was a relatively new finding, and they were not sure what to do if it was found in myeloma patients. The general consensus was to further explore in which cases pomalidomide should be preferred over lenalidomide, but other preventative measures are unknown. 

It's impressive to see science advance in genetics and diagnostics. This type of research gets us closer to safer and more personalized myeloma care. 


The author Jennifer Ahlstrom

about the author
Jennifer Ahlstrom

Myeloma survivor, patient advocate, wife, mom of 6. Believer that patients can contribute to cures by joining HealthTree Cure Hub and joining clinical research. Founder and CEO of HealthTree Foundation. 

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