COMy 2026 | Advances in risk assessment for smoldering multiple myeloma

When we see patients with smoldering myeloma, the first question they ask us is, what is my risk of progression? Because it matters a lot. I can make a decision if I have a 60-70% chance of progressing in the next two years versus a 5% chance of progression in the next two years. And I think that’s very important for us to help them make those decisions of, should I go on therapy or should I continue watch and wait. The 20/2/20 model or the IMWG model has been around for a few years and it’s a very good clinical model because it’s easy and simple and we can all calculate it, but there are a few problems with it. One, it’s static, it does not look at the trajectory or the dynamic changes of my M spike or my light chain, so if I have a low-risk 20/2/20, but my numbers are increasing every three months, it doesn’t account for that. Or vice versa, if I have a high-risk 20/2/20, and my doctor tells me I’m high risk, but I’ve been stable for the last five years, six years, I’m probably not that high risk. The other thing that’s wrong about our way of communicating with our patients is we lump them together. So when we tell a patient you’re high risk, that’s lumping multiple groups together to give them that number. And it’s not an individualized risk. So we try to improve on that by adding to the 20/2/20 and trying to say, can we look at the dynamic models? Can we look at personalized risk for my own data? Can I look at it at two years, at five years, at 10 years, and put my own numbers and get my own personal risk of progression and not just the group risk? And Pangea, which is basically the name of it, which is putting all of our continents back together, the good old way of us collaborating together, is trying to answer this question. It’s trying to say the same data of 20/2/20, but on a dynamic model, so M-spike and light chain. It’s adding hemoglobin and creatinine, so very simple clinical data that we all have in our hands. It’s actually also saying, if you don’t have a bone marrow biopsy, we don’t have to have it, because it takes away that need for us to repeat again and again the bone marrow biopsy, which is very important for our patients. And it puts for you your own personal risk, but also the group risk if you want to go on a clinical trial. The one thing to remember about Pangea is that we have on the website, and it’s available for anyone to plug in their numbers, we have the 20/2/20 data and your Pangea data, and you’ll see that sometimes you may be high risk by 20/2/20, but intermediate risk by Pangea because it’s calculation for risk of progression is slightly different, and it’s not only at 44% at two years. That’s considered intermediate risk. So again, a way for us to empower our patients, to give them the information in their hands. Hopefully, we will have an app soon and hopefully it will be part of Epic and other EHRs so that everyone can access it.

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