Tell your musician friends to donate a song today on Songs For Life to raise funds for multiple myeloma research! Dr. Jesús San Miguel, MD, PhD University of Navarra, Spain Interview Date: October 3

 Dr. Jesús San Miguel describes his deep work for high risk myeloma patients. He starts by discussing the need for minimal residual disease testing - it avoids over or under-treating patients. When patients begin with myeloma treatment, they usually have high levels of tumorous plasma cells. After treatment, they usually have normal levels, but it is critical to know whether those remaining plasma cells are normal or residual malignant cells. The minimal residual disease (MRD) test can determine this. He shares that a standard international flow cytometry test is almost there, but that patients still need the test done at a myeloma academic center. He dives into the detail of high risk myeloma, naming the high risk features including  4;14 translocation, 1Q, hypodiploidy, 17p deletion, being Stage III and having high LDH levels. However, he stresses that having one of the high risk features is not as important as a patient having multiple features, which are called "ultra high risk." He states that patients benefiting most from the standard use of transplant, proteasome inhibitors and IMiDs are the standard risk patients. He describes the new approach he is taking to further treat high risk patients more effectively - first, to create clinical trials for these patients specifically or to stratify patients before they begin the latest clinical trials before the study starts, so he can see which approach worked the best for each high risk feature. He notes that if patients are stratified before a study starts, then a variety of approaches can be taken by different multiple myeloma centers and then information can be compiled to give the myeloma community as a whole greater insight about specific groups of patients. He notes that in Europe, data exists that shows benefit for high risk patients using the double transplant. He is excited about the new anti-CD38 monoclonal antibodies for high risk patients but notes that time will tell if they are effective against high risk myeloma. He describes an upcoming clinical trial for high risk smoldering myeloma patients which will include carfilzomib, lenalidomide, dexamethasone, autologous stem cell transplant and lenalidomide maintenance with the objective for a cure for these patients. He does not recommend low or standard risk smoldering myeloma patients to receive treatment. He describes the goal to also address the bone marrow environment to see if the cells in the bone marrow can be treated to prevent the myeloma from growing.