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COMy 2025 | Unanswered questions in myeloma: understanding its heterogeneity & genomic instability
In this video, Meral Beksac, MD, Istinye University Ankara Liv Hospital, Ankara, Turkey, comments on the unanswered questions in multiple myeloma (MM), highlighting the disease’s heterogeneity and genomic instability, which make it difficult to predict patient outcomes and response to treatment. Dr Beksac emphasizes the need for better tools and personalized approaches to risk stratify and manage the disease, but notes that the introduction of next-generation sequencing (NGS) and a new high-risk definition represent a step forward toward personalized care. This interview took place at the 11th World Congress on Controversies in Multiple Myeloma (COMy) in Paris, France.
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Transcript
For myeloma, I think the unanswered question currently is that it’s a heterogeneous disease. So, multiple myeloma was initially defined to summarize that it occurs in different parts of the body, but today we know that multiple myeloma has different subtypes which are characterized by molecular features, and this is unfortunately not static, it’s dynamic, and myeloma has genomic instability, which means a patient who is diagnosed with a clone may have subclones which are present in the beginning...
For myeloma, I think the unanswered question currently is that it’s a heterogeneous disease. So, multiple myeloma was initially defined to summarize that it occurs in different parts of the body, but today we know that multiple myeloma has different subtypes which are characterized by molecular features, and this is unfortunately not static, it’s dynamic, and myeloma has genomic instability, which means a patient who is diagnosed with a clone may have subclones which are present in the beginning. The clone which is sensitive to the drug that is being introduced may disappear, but the subclones which were very minor in quantity in the beginning may start to appear later in the course of the disease. And it’s hard to define which patients will develop this kind of evolution. And the genomic instability is not standard for all. So, I think standard-risk patients are defined based on the composition of the majority of the clones, and we do not really evaluate the subclones. But with the introduction of next-generation sequencing, now we are able to identify these small, very minor clones, and the newer classification, the IMS Barcelona new high-risk definition is a step forward, and we need better tools to recognize and also to give different treatments based on a personalized approach. I think these are the answers that we will have in the near future, hopefully.
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