What is the iStopMM study?

What is the iStopMM study?

Investigators in Iceland, led by Sigurdur Kristinsson of the University of Iceland, sought to evaluate what would happen if screening for MGUS were widely available. Would it lead to an improvement in overall survival? They launched the Iceland Screens Treat or Prevent Multiple Myeloma study, which is described as the first population based screening study for MGUS that includes a randomized clinical to follow up in treatment strategies. The iStopMM study invited everyone living in Iceland, born in 1975 or earlier, to take part in one of the most extensive scientific screening studies ever conducted. All eligible individuals were invited to participate. A letter containing a detailed information brochure and consent form was mailed to eligible individuals, and an extensive campaign on social and conventional media was launched, introducing the study to the Icelandic public. This campaign was followed by phone calls to those who had not yet signed up for the study. A total of 80,759 people registered to be part of this study, which is equivalent to a 54% participation rate, a unique achievement worldwide. After enrollment, serum samples for screening are collected alongside the collection of blood during clinical care in the universal Icelandic health care system. Results from iStopMM are currently being presented at many scientific meetings throughout the world. The iStop multiple myeloma study is a quite an incredible, undertaking by an excellent team in Iceland and I think they are trying to, first of all, find the exact, number of patients who have monoclonal gammopathy of undetermined significance. So, it's a small island, 300,000 people. They've been able to enroll a large number of people on this study. And I think number one is that what we're learning about is the true incidence of MGUS and then the other thing is that who is at high risk, who has significant disease, who should be followed, periodically and who should not. And I think the data emerging, from this study that really identifies a subset of patients that we should not be testing, again, and then subset of patients that we should worry about. So I really think it's an a great study. It's a you know, it's an early years of that study. So the longer we follow these patients on that study, we're going to learn a lot about the natural history of monoclonal gammopathy of undetermined significance. And the other thing that Iceland, they all have their, DNA sequence. So we will figure out if there is any genetic predisposition for that conditions or for progression. And so we are learning a lot from that study. So kudos to the Icelandic team for doing that. They basically looked at 80,000 people, screened them all. Those who had smoldering myeloma were notified. And then everyone else was randomized to either do nothing or evaluate them further or evaluate them very extensively, bone marrow biopsy and so on. And that helped us identify people who actually are smoldering myeloma. Despite this thinking that they were likely MGUS. So it's important to have that extra step of potentially examining further the tumor burden. Now that could also lead to lead time by and understanding better. Are we, you know, creeping smoldering myeloma earlier? That may be true, but understanding the biology is important. It doesn't have to make us decision making and clinically making decisions on those patients. But it can help us understand what is the biology of those patients and what are the factors that lead to some smoldering, looking more like MGUS and never going on to progress. So I really think that let the science lead to the decision making, rather than us imposing our ideas on the science. Let's see what happens when you screen all those people. Let's see what happens when you identify further how much tumor burden they have. And then let's see what happens genomically and immune, regulation wise, in those early cases that you identify so that we can understand better the biology of the disease, and then later on adds more clinical significance add more how can we therapeutically intercept those? So let's allow science to understand that better. And then we start understanding how to use it for our patient care.