Study on Risk Stratification in Smoldering Myeloma Patients | Malin Hultcrantz, MD, PhD | IMS 2023

My name is Mollen Holt-Krentz and I work at Memorial Stone Kettering in New York. So for this study, we wanted to look at our smoldering patients and we wanted to see if we can find a better way of risk stratifying these patients because the risk stratifications that we have right now, they're based on the baseline level of the myeloma markers. So we wanted to see how does this change over time and can we use this information. So we looked through all of our patients at Memorial Stone Kettering and we identified almost 400 patients that we have monitored over time. So the first thing that we did was to divide these patients into quintiles of where they were in terms of the baseline level. So for these patients, we saw that the patients with the highest baseline levels of course had the highest risk of progression. But then what we did as the next step was we looked at the change over time over the first year of follow-up. Now we divided patients into quintiles and the patients with the highest quintile of change or the highest change over the first year, they had a very high risk of progression. So those were the patients with the M-spike change of more than 0.3 grams per deciliter or free light chain ratio change of more than 50%. So in these patients, we did see a high has some ratio of change, it was almost three. So similar to those patients with a high baseline level, those were in the highest quintile also of baseline. What we did as the next step was we looked at those patients who actually progressed over the first year. Then we saw that these patients were 50% were in the highest baseline quintile. So that means that 50% were not in the highest quintile of change. And there we see that this change and the development over time really is important. So that is also where the genomics and the disease biology comes in. So until we can do a genomic assessment of every patient in clinic, we can use these markers as an easy way of looking over the first year and in a dynamic way, assess the risk score of these patients. So in conclusion, we saw that the patient with the high baseline level and a high rate of change over time over the first year did have an increased risk of developing multiple myeloma. And I also want to give a shout out to Tiresia Aglaki who is a fellow at Cornell who did a lot of this work as well.