How to Better Diagnose Patients With High-Risk Myeloma | Martin Kaiser, MD | ASH 2022

Hello, I'm Martin Kaiser. I work at the Royal Marsden Hospital in London and I'm also a translational researcher at the Institute of Cancer Research in London. I had the pleasure of presenting at this meeting a large collaborative project that we have performed over the last months which looks at how to better diagnose patients with high risk or ultra high risk myeloma to identify really a group where our probably research should be focused on due to the high end met needs but also to have a better diagnosis probably in standard of care where it is actually appropriate. Some patients may want to know more, others may want to know less about the disease, but actually there's definitely a way to improve giving an individualised prognostic estimate for patients and that can help potentially in the future in guiding treatment. We are performing trials that will hopefully optimise therapies but it can also help with just defining general expectations about care or for example how often someone comes back to a clinic, how careful we are to watch out for relapses for example and we have been making quite a lot of use of that in our practice because we have been using refined genetic profiling for a while during COVID where we could keep some patients out of hospital where we are were less concerned about their relapse risk and others where we had a high relapse risk we brought them back quite frequently to the hospital just to balance the risk of their disease and the risk of coming to the hospital in that unique time. Now the coming back to the project and the analysis that we did we actually invited collaborative trial groups to provide a randomised controlled clinical trials where an extended set of genetic markers were evaluated as well as industry collaborators and on a completely voluntary basis whether they would be willing to provide data from their randomised controlled trials with available extended genetic profiles and that means that all of the patients that were included in our analysis had a complete set of information absent presence on the markers game 1q adverse translocations and deletion 7mp and we analysed the data with respect to as to whether the patients had none of these high risk markers present or whether there was only a single marker present or whether two or more of these markers were overlapping which we termed double hit. Now this had been done in smaller studies before but for example in the UK trial where we have looked at this these patients were mostly treated with just one type of treatment the IMEDS or Revlimid or Thalidomide so there were open questions about whether that would be consistent as well in other treatment conditions in newly diagnosed patients but also whether the whole prognostic association was holding up in relapse refractory situation. We were very fortunate in that we got a collection of data together which included in total over 11 000 patients across different treatments conditions of which 6 500 had a complete genetic data set as just described and we saw consistently in a meta analysis that the presence of a double hit so two or more high risk markers was associated with consistently bad outcome for these patients and this was significantly different from having just one high risk marker so that characterised across all the trials very consistently a group of about 15 percent of patients who really deserve more attention and I think we are making a very strong case with this meta analysis that on the one hand side this should be reported more widely for example in ongoing research clinical trials that are now being performed just to give a better characterisation of high risk groups in these trials but in standard of care as well with really more universal access to genetic profiling for patients.