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ASH 2025 | Measuring CTCs to improve risk stratification in newly diagnosed multiple myeloma
In this video, Mattia D’Agostino, MD, University of Turin, Turin, Italy, discusses the role of circulating tumor cells (CTCs) in improving risk stratification in newly diagnosed multiple myeloma (MM). Dr D’Agostino highlights that the addition of CTC data to standard staging systems, namely the second revision of the international staging system (R2-ISS) and the IMWG consensus genomic staging (CGS), enhances prognostication, with CTC levels and R2-ISS independently predicting progression-free survival (PFS). This interview took place at the 67th ASH Annual Meeting and Exposition, held in Orlando, FL.
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Transcript
So we are used to thinking about myeloma as a disease of the bone marrow because plasma cells and also the neoplastic plasma cells reside within the bone marrow, but if you measure them with a technique that is sensitive like flow cytometry, you’ll find that almost 90% of our patients have circulating tumor cells at diagnosis. So there are several reports showing that the levels of circulating tumor cells correlate with the prognosis of our patients...
So we are used to thinking about myeloma as a disease of the bone marrow because plasma cells and also the neoplastic plasma cells reside within the bone marrow, but if you measure them with a technique that is sensitive like flow cytometry, you’ll find that almost 90% of our patients have circulating tumor cells at diagnosis. So there are several reports showing that the levels of circulating tumor cells correlate with the prognosis of our patients. In this abstract, we tried to investigate the role of circulating tumor cells in addition to the standard of care staging system definition of high-risk. So the last staging system that has been published is the revision 2 of the ISS, and this year the International Myeloma Society, the IMWG, proposed a shared definition of what we should call high-risk myeloma, and this staging system is called consensus genomic staging. So we investigate the role of CTCs on top of these two standard of care staging systems.
So in the first part, we focus on R2-ISS. So if you add CTCs to the R2-ISS, you improve your ability to do prognostication. So the performance of the models with the CTCs is higher in terms of PFS, and moreover, both the CTC levels and the R2-ISS predict the PFS in an independent fashion. So we demonstrated that if you stratify the single class of R2-ISS according to CTC levels, low or high, with a 0.02% cutoff, you end up with very different outcomes. The same you could apply to the consensus genomic staging, in which if you separate your standard-risk and your high-risk patients according to the level of CTC, you end up with very different outcomes. So our data suggests that you should include the measure of CTC by flow cytometry at diagnosis in the new staging systems. And I think that it is now the time that CTC should be measured in all patients at diagnosis.
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