iStopMM Trial in Iceland #myeloma | Jón Þórir Óskarsson, MSc | ASH 2023

So hello, my name is Jonn Thorlur-Oskarsson. I'm a molecular biologist and a PhD student at the University of Iceland. And I also manage flow cytometry studies in the ISTOMM trial that's currently running in Iceland. In the ISTOMM trial, which is a population-based screening study for multiple myeloma precursors and the randomized trial follow-up strategies, we're really looking at can we detect myeloma at an asymptomatic state and can we by that also start myeloma treatment earlier than we would have because only under 10% of myeloma cases are detected at an asymptomatic state. And there is growing evidence for the benefit of early intervention. So when the myeloma patients present at a health care facility, it comes with less active symptoms of the disease. So in that study, we are also, and what the study I am presenting here at us in San Diego this year is on the topic of lichenemgus. Lichenemgus is diagnosed, it considered a precursor for lichen multiple myeloma and related conditions. And lichenemgus is diagnosed by having abnormal free lichen levels. But that diagnosis is only an indirect evidence for an underlying monoclonal cell population. So what we wanted to do in this study is to dive a little bit into the biology of lichenemgus. And what we did was we performed flow cytometry analysis to confirm an underlying clonal plasma cell population in individuals with lichenemgus that were diagnosed in this I-STOP-MEM screening study. And what we found was that in less than half of lichenemgus cases in that study, which were diagnosed based on a standard definition of lichenemgus, had an underlying monoclonal plasma cell population. And when we followed these individuals, we saw that a free lichen ratio really was highly associated with having an abnormal clonal plasma cell population in the bone marrow, particularly having a free lichen ratio over 3.15 was highly associated with having a clonal plasma cell population in the bone marrow. Well, in contrast, those that were under this cutoff value were highly associated with not having an underlying clonal plasma cell population. And if we follow these individuals quite regularly in our study setting, and what we found that we found no evidence for a progressive disease in those that were under this cutoff value, which we were looking at. And moreover, we didn't find any evidence for an evolving FLC ratio or any other marker of disease progression. And this is important because if we can better understand the biology and which individuals we need to monitor for progression, we can really tailor the management of lichenemgus better. And these results really complement another abstract from the STMM team, where my colleague Thorolong is going to present a revised definition of lichenemgus. This will be a more stringent criteria and will therefore help to drastically reduce this number of lichenemgus individuals which seem to have a clinically insignificant condition.