Update on Risk Stratification in MGUS and SMM | Doctors Callander and Beksac | IMS 2023

Hello, I'm Natalie Kalender from the University of Wisconsin. And my name is Merabek Seç from Ankara University, Turkey. And what we're going to talk about for a few minutes today are states that predate the development of myeloma. There's two of these. One is called MGUS and the other is called smoldering myeloma. Smoldering myeloma is a relatively rare thing. There's only about, somewhere around half a percentage of people in the population that are going to develop or be found out to have smoldering myeloma. And one of the things that we're both interested in in our research is how do you pick out patients with smoldering myeloma who might be more likely to develop myeloma than others. Right now we're doing mostly clinical determinations of that. There's a few features we look at. One is the amount of monoclonal protein or M protein that you might have in the bloodstream. The other is the amount of free light chain. A third is how many plasma cells they find on a bone marrow biopsy. And then we're also looking at chromosome changes in the plasma cells themselves. And having two of four of these things being altered can lead you to a higher risk of developing myeloma. There are many other areas of research underway to start looking at more molecular things that you might find in a bone marrow biopsy or maybe even the blood. But the big thing what we're trying to figure out is are there people that we could offer treatment to early in their diagnosis of smoldering myeloma and prevent them from ever developing myeloma in the long run. And that's been a focus of a lot of the presentations here at this meeting. And I think we're going to probably hear a lot more from the extremes of very little intervention to all the way to things like transplantation. Yeah. So my job for tomorrow is going to be talking about on monoclonal gummopathy of undetermined significance. The title may seem very obscure because undetermined still after so many years that this entity has been defined, we still keep that title. But nowadays we know more and more about it. Monoclonal gummopathy is, if you look at it in the frequency in the total population, is quite frequent. And we start to observe it after the age of 50. And with each decade it increases. And when you reach about 80 years of ages, it becomes like about one out of 10 has this abnormality in the blood if you look carefully. But does it have a meaning? Well, it doesn't have the meaning most of the time. Since when myeloma is recognized and diagnosed, only like 2 to 6% of those patients have an MGUS background when you have followed them. So most of these, all the MGUSs do not transform, change into a conical myeloma. The frequency is much less. And for small-ringed myeloma, it's more frequent, but still it's not 100%. The thing is the main issue is how to recognize those patients who have the highest chance of transforming to myeloma. And why do we care about this? It's because when myeloma is recognized and diagnosed, sometimes it takes a long time. And there is a damage in the organs, in the bones, in the kidneys. And it is sometimes too late to change it back to normal with the treatment that is instituted immediately. So this is the reason why we are trying to recognize patients who are more prone to become myeloma. So Meryl, if somebody out here has had MGUS or been told that they have MGUS, what would be some of the things that they should pay attention to to make sure that their doctor might know about? I mean, the doctor, if the doctor is a hematologist and who is interested and who is knowledge about myeloma, that's the perfect choice. And the doctor will lead the patient. And for some patients, once a year, maybe once a year, it is even not needed. So but for the majority, maybe. But for those patients who haven't visited such a physician, I think that's the place where there needs to be some adaptation required. I think if somebody has been told that they have smoldering myeloma, the biggest controversies right now are whether people should receive some sort of treatment or not. And I would just always ask that you look in your area for a clinical trial because we don't know the answer yet. There are definitely some people who look like they'd meet a diagnosis of smoldering myeloma and probably shouldn't be treated. But there are there are a number of patients who have these some of these risk factors that I mentioned that have a fairly high likelihood of developing myeloma. And so you should always try to inquire. There's lots of ways to do that. Going through some of our National Cancer Institute here in the U.S., other organizations, patient support groups like HealthTreat. And they can point you in the right direction about clinical trials for smoldering myeloma. Exactly. And the lab counts. I think sometimes patients are very well informed about their lab values. And if there's an increase in the total protein, which is most of the time done in the routine exam, and if there is an increase in time and if the increase is quick, that's an alarming signal.