My name is Craig Cole and I'm a myeloma doctor at Comanos Cancer Institute in Detroit. I'm an associate professor at Wayne State University's Medical School in Detroit where I see patients. I'm also an associate professor at Michigan State University's Medical School in Lansing where I also see patients. And it's been a really exciting past couple of weeks between the American Society of Clinical Oncology meeting in Chicago, the International Myeloma Working Group meeting here in Milan, Italy and then the European Emetology Association meeting also here in Milan. Now I say the highlights, I think one of the tippy top things that are important is that we've redefined what high risk myeloma is. And I think this is really exciting because what has happened is that as these new therapies have come out, new therapies in the way of daratumumab and isotoxumab, new therapies and us using triplet and quadruplet therapies to treat newly diagnosed myeloma, what's considered high risk before has actually become standard risk because these therapies are so effective. And now it has kind of bubbled to the top are the new high risk patients that when we give modern therapy to patients, we now, a lot of the old high risk has fallen into standard risk, easier to treat and there's a new high risk. And that's when you see a deletion of the 17th chromosome, when you have a mutation in a gene that's really important for a cancer treatment called P53 and then when you have doublets of cygenic abnormalities such as a deletion and addition of the first chromosome, when you have chromosome one abnormalities associated with the classic high risk category such as 414, 1416 and 1420. They've also included the beta-2 microgobulin which we have used for staging for decades and the beta-2 microgobulin is a protein that's seen on myeloma cells are shed into the blood and excreted by the kidneys. And so when there are high levels of beta-2 microgobulin that tells us that there's lots of myeloma in the body independent of what the M protein or the light chain test tell us. So that's an idea, so the new cytogenetics gives an idea of the mutations that are difficult to treat in myeloma and the new category of the high beta-2 microgobulin being over 5.5 tells us that someone has a lot of myeloma that we need to bring down. And that is not only going to be important discussions to have with your doctor but it's going to be really important targets for us to reach to. We've already beaten a lot of the high risk myeloma which is why we had to change the definition and now we've set the bar even higher so that we can eliminate high risk myeloma in total in the future.
HealthTree • August 21, 2025