Results from the Optimum/Muknine Trial | Martin Kaiser, MD, FRCP, FRCPath | ASH 2023

I'm Martin Kaiser from the Royal Master Hospital in the University of Cancer Research in London. I present on behalf of our group our results from the OptiMAC 9 trial for patients with high-risk myeloma. This is a trial that we started about seven years ago when we recognized very clearly that patients with high-risk myeloma have a high unmet need. It was a long-term research project where we identified genetic markers, how to identify these patients early so that we can straight away from the beginning without having to do any further tests offer a different treatment. The OptiMAC trial was reported in a high-ranking journal earlier this year. It included overall 470 patients that were screened with genetic markers to identify with high-risk disease. These patients had a markedly better outcome than standard of care treatment with a therapy with quintuplets, DARA, CBRD, but then particularly with combination DARA, VRD for 18 months after the transplant that these patients received. We had a really remarkable improvement of PFS, 77% at 30 months, but we never noticed that about 20% of patients unfortunately relapsed despite this very good treatment early on. Now the question is of course who are these patients, what characterizes the disease, because if we identify this again very early we can offer them in the next iteration hopefully with new treatments coming along a better treatment pathway. So we looked very deep into the genetics and we benefited from that we invested a lot of time and effort into characterizing the disease of these patients very closely. So we found that particularly patients who had three genetic high-risk markers or a gene expression signature and or plasma cell leukemia had the highest risk of an early relapse despite this excellent treatment. So with that knowledge of course we can now really design and plan ahead because in contrast we saw that there were really patients that are benefiting a lot from the treatment in this trial. So it kind of segments the group into having more information for patients about the disease to start informing treatment strategies and potentially considering trials or other options for the patients that we know are unfortunately not benefiting well enough from current treatments. So we're hoping we're making a case for better diagnosis of the disease, better genetic profiling and really informed discussions to improve patient outcome jointly.