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ASH 2024 | The current approach to risk stratification of smoldering myeloma
Tarek Mouhieddine, MD, Mount Sinai Medical Center, New York City, NY, discusses the current approach to risk stratification of smoldering multiple myeloma (SMM), highlighting the importance of looking at both the cytogenetics of myeloma cells and as well as the immune microenvironment. Dr Mouhieddine emphasizes that no currently available model is perfect, as smoldering myeloma exists on a spectrum. However, combining models and considering several factors aids clinicians and patients in better understanding the disease and its prognosis. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (AI-generated)
So over the years, there have been many studies that looked at smoldering myeloma. And smoldering myeloma is mostly a spectrum rather than a separate entity that you can really categorize into blocks. However, in order to better simplify things for us and for patients, that’s why we try to categorize, to try as much as possible to predict outcomes for patients...
So over the years, there have been many studies that looked at smoldering myeloma. And smoldering myeloma is mostly a spectrum rather than a separate entity that you can really categorize into blocks. However, in order to better simplify things for us and for patients, that’s why we try to categorize, to try as much as possible to predict outcomes for patients. And that’s what led us to group smoldering myeloma into low-risk, standard risk, and high-risk.
And of course, when we look at risk stratification, we have to look at the tumor as well as the immune microenvironment. Initially, it was all about the myeloma cells. But now we know with more studies coming in that looked at the bone marrow of smoldering myeloma patients, we know that specific cell populations can be associated with higher risk. So the best way now to risk stratify, clinically at least, is to first of all look at the cytogenetics of myeloma cells. If you have high-risk cytogenetics that would predict a higher risk to progress to multiple myeloma.
If you have other features that could indicate that there is a higher chance of progression, which different models have looked at. And that could include, for example, having the IgA subtype of smoldering myeloma or having more tumor cells in the bone marrow. For example, having 50% of the bone marrow filled with multiple myeloma cells, that is a high-risk feature to progress to multiple myeloma. We also look at the immune microenvironment, and that’s by single-cell studies as well as studies by flow that profiled patients’ bone marrows at a single time point or even over time to see how that changes as they’re progressing to multiple myeloma. And that has definitely found that there are specific cell types like increased antigen-presenting cells or T-cells having higher granzyme B expression or secretion, all of which can be associated with a high risk of progressing to multiple myeloma.
So to put it all in a nutshell, there are a lot of models out there. No single model is perfect. However, we try as much as possible to bring in the information, combine them together, and try to see if we can help patients better understand their disease and their prognosis.
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Disclosures
Sanofi: Consultancy.
