So my name is Merabek Sert, I'm from Istanbul University, Ankara, Turkey. I'm attending ASH and here I'm going to be presenting a couple of abstracts. And one of the abstracts is entitled on the role of an early relapse score to predict functional high risk. This is a topic which is of importance for myeloma patients. Why? Because we know that multiple myeloma is a heterogeneous disease and there are patients who have very good risk as well as those who present with what we call ultra high risk features. And everybody is trying to find out and also to find ahead of time which patients are going to be having this type of high risk features without the disease advances. And there have been earlier attempts by the European and also from colleagues from United States, they developed scores, but the prediction rate for the first 12 months after stem cell transplant was not that high. Within the European Bone Marrow Transplantation Registry, we aim to revise this topic and we developed an EBMT early relapse score which was published two years ago. And this score was based on three parameters, very basic, which is very applicable worldwide. It's based on the international staging system, a diagnosis, and two additional features that are detected at the time of stem cell transplant, prior to transplant. And these features are performance status and also response to the induction regimen. Based on these, we were able to predict that within the first 12 months, there are some patients who are almost have a 50% of relapse risk versus those who have less than 5%. So these are five category of patients. This study did not include cytogenetics. As in within the EBMT, among 15,000 patients, not all of them had the cytogenetics available to be included in the score. To be able to overcome this hurdle, we approached the World Bone Marrow Transplant Group, which also has data from five different registries, again, about 15,000 of patients. And the majority are coming from CIBMT, also additional registries from worldwide, including Australia, Asia, Japan, and the Mediterranean region, and also some EBMT patients which were not included in the original study. Based on this, we were able to present here in this Congress that within the standard risk and also among the high-risk patients who are presenting based on their cytogenetic feature, the score is able to differentiate and recognize the same very low and also high-risk patients who are going to progress within the first year after the stem cell transplant. So we don't need to include cytogenetics into the score because the validity of the score is present for both groups. So this is what we have found out so far. And during this meeting, there are other groups who are trying to find out the factors that can predict functional high-risk, which is the early relapse patients within the first after transplant or within 18 months from diagnosis. These studies, one of them is a very sophisticated study looking at the gene structure from the COMPASS study, and they were able to see that even those patients who have standard risk features based on their gene expression, it doesn't exclude the risk of early relapse. So I think our data has validity based on the response to induction, which is also shown in that study from the COMPASS data. Response prior to the transplant being less than PR was also predictive. I think in future we might be able to have this approach accepted by more authorities and to be applicable for daily practice. And of course there is space to improve the score, and that's what we are working upon. Because those patients are the ones who are candidates for more advanced treatments, and so without having the clinical features of an advanced disease before they have renal impairment or bone destruction, then those patients can be approached earlier with such as CAR T therapies or vice specifics, which are more expensive and hard to reach treatments. And these are the ones who are candidates for novel treatments and not the low, those standard maintenance approach. There are some now new trials which are trying to approach these patients, but their definition of functional iris is not based on our score. Maybe for future the clinical trialists may adapt our score in their inclusion criteria. I think regardless of the risk, all patients deserve the best treatment, that's for sure. And currently quadriplets are the best treatments, and I think based on their additional features such as frailty, their renal functions, their kidney functions, and their social status being able to visit the hospitals frequently. So these are the determinants of how they can receive these quadriplets, but it's also possible that they may start with a lower intensity of dosing and then as time goes by and they become more stronger and more, their endurance is more strong so that they can afford more intensive regimens. That's the way to go because myeloma is a heterogeneous disease, not in terms of from difference from one patient to the other, but within the same patient there might be cells who have different features, both in biological and also response to treatment. And so the way we administer the best treatment in the beginning, it's possible that we will be able to get rid of that heterogeneity which may appear based on a less intensive regimen that we can induce refractory and resistant cells that will become difficult to treat later on.
HealthTree • December 17, 2024