Should We Be Intercepting Blood Cancers?

A conference called Intercepting Blood Cancers (IBC 2023) was recently hosted in Madrid, Spain for blood cancers including multiple myeloma, MDS, AML and CLL to answer the question “Can and should we intercept blood cancers at earlier stages?”

The conference brought global experts in genetics, immunology, clinical trial creation and clinical experience together to discuss the complexities, tradeoffs and pros and cons of catching (and potentially treating) these diseases at earlier stages.

In multiple myeloma, precursor conditions can include monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma. In MDS and AML, a condition called CHIP can be present.

At the conference hosted by Irene Ghobrial, MD from Dana Farber Cancer Institute and Jesus San Miguel, MD of the University of Salamanca in Spain, the researchers had an opportunity to discuss and challenge one another in a unique dialog.

Key questions included: Is there benefit to treating early? What exactly does it mean to “intercept” a precursor condition? What is sufficient? What if patients aren’t likely to progress? What do we consider progress? Is high-risk smoldering myeloma really just active myeloma? Does early treatment matter for long-term outcomes? Or do you just prevent end-organ damage by treating early? How can clinical trials be structured for prevention?

Myeloma speakers included individuals with expertise ranging from immunology to genetics. The top tier experts included Francesco Maura, MD, University of Miami, Gareth Morgan, MD, PhD, NYU Langone, Leif Bergsagel, MD, PhD, Mayo Clinic Scottsdale, Ken Anderson, MD, PhD, Dana Farber Cancer Institute, Madhav Dhodapkar, MD, Emory University, Urvi Shah, MD, Memorial Sloan Kettering Cancer Center, Bruno Paiva, MD, University of Navarra, Maria-Victoria Mateos, MD, University of Salamanca, Rafael Fonseca, MD, Mayo Clinic Scottsdale, Shaji Kumar, MD, Mayo Clinic, Angela Dispenzieri, MD, Mayo Clinic, Meletios Dimopoulous, MD, National and Kapodistrian University of Athens, Sigurdur Kristinsson, MD, University of Iceland, Nicole Gormley, MD, FDA, Elizabeth O'Donnell, MD, Dana Farber Cancer Institute and others. 

Key conclusions of the meeting were clear: 

• Better risk stratification is needed so doctors don’t treat patients who aren’t likely to progress
• Risk models need to take into account more than is currently used because today’s models are inconsistent and not personalized enough
• Risk needs to assessed more frequently and not just at one point in time because the risk is always changing
• Better and more sensitive testing is needed (whole genome sequencing, circulating tumor cells in the blood, etc)
• More use of blood-based tests are needed to avoid frequent bone marrow biopsies
• More study is needed to watch what the immune system is doing, especially as immunotherapies get moved into earlier lines of therapy, including precursor conditions

Because there was so much content in the two-day meeting, HealthTree for Multiple Myeloma will cover the meeting in a series of articles to that will follow to discuss these thematic points. The conversations and debates were fascinating, and patients need to better understand the thinking behind decisions as new approaches are explored.