So good afternoon everyone, my name is Luca Bertamini. I come from Rasmus MC in Rotterdam, the Netherlands, and I'm here at EHA 2025 to talk about circulating tumor cells for the stratification of myeloma. And what we are presenting here at this conference is really an important work. It's the first results of a large collaboration between a lot of centers across Europe, more than five national groups, trying to put together data from patients at diagnosis with myeloma. And we have been able to collect data from more than 2,500 patients to really study this specific biomarker that we have been studying already in the last year in many different groups separately. And this biomarker is called the circulating tumor cells. So what are circulating tumor cells? So myeloma cells are generally in the bones as we know that, but sometimes or actually quite often they go out and we can find them in the peripheral blood of patients. So what we, many different groups, as I mentioned, showed already is that patients that have these circulating cells have a worse prognosis, meaning that they tend to progress earlier during their disease history. And what was not clear is that what defines really patients that have a lot of these circulating cells? And can we really certify patients using this biomarker, including other biomarkers? And this is applicable to all categories of patients, young, elderly, patients that are eligible or not eligible to transplant, patients that are treated in clinical trial or in a real-world practice. So we really try to answer these questions and address these questions with really a large set of data. And our main results and findings are really promising. So we noticed that having more increasing levels of circulating tumor cells really is associated to a worse prognosis. And this is independent of other risk factors that we test, like such a genetic risk by fish or international staging system, LDH levels. But also this is true for a lot of categories of patients, the one I mentioned before. So for patients that are both eligible to transplant and young, but also patients that are frail and elderly. And this is really important because this shows us this biomarker is really important for the total population of our patients. And then what we did next is we tried to identify an optimal threshold to identify patients that are really at high risk. And we suggest actually two thresholds, one for, let's say, intermediate high risk, which is 0.02% of the cells, and one really for patients that have a really ultra high risk. So really with a poor prognosis, which is around 2%, similar to what we call also plasma cell leukemia. And this is really important because we really want to certify patients the best because the next step would be, of course, to try to tailor better treatment. Some patients probably deserve more treatment than others. And I think we think that a risk adapted treatment is really the key for the future of myeloma. So how can we know if we have circulating tumor cells in the blood? How can a patient know if a diagnosis they have or don't have, or if they have a lot of this biomarker? So it's something very simple. It can be tested with a simple blood draw and can be tested in really a lot of labs because it doesn't require very advanced technology. It's just simple flow cytometry, which is the test that your doctor asks for when you test the bone marrow aspirate to confirm your diagnosis and also to test for minimal residual disease negativity after therapy. So it's really something very simple to implement in a clinical practice in the future. We already have guidelines on how to test MRD and this can be really applied the same way, just on a different type of sample instead of the bone marrow on the peripheral blood. Because the cells really look very similar, they have a similar phenotype. So it's really simple and can be really in the future be applied worldwide.
HealthTree • June 25, 2025