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IMS 2026 | Blood-based technologies for diagnosis and monitoring in multiple myeloma
Shaji Kumar, MD, Mayo Clinic, Rochester, MN, discusses the future role of blood-based technologies for diagnosis, risk stratification and monitoring in multiple myeloma and other plasma cell disorders. He highlights circulating tumor cells (CTCs), circulating tumor DNA (ctDNA) and mass spectrometry as approaches that could reduce reliance on bone marrow assessment, while noting the need for further validation, regulatory approval and prospective studies to establish how these technologies should be used in clinical practice. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
There’s a variety of tools that we can use in the peripheral blood for diagnosis, risk stratification, and monitoring of plasma cell disorders. At the time of diagnosis, clearly, some of these genetic abnormalities that we currently obtain through FISH are important for prognostication and to some extent, therapy selection. And increasingly, studies have shown that we can detect those primary abnormalities that we are looking for in FISH in the bone marrow by looking at sequencing in the peripheral blood on the circulating myeloma cells and maybe even circulating tumor DNA...
There’s a variety of tools that we can use in the peripheral blood for diagnosis, risk stratification, and monitoring of plasma cell disorders. At the time of diagnosis, clearly, some of these genetic abnormalities that we currently obtain through FISH are important for prognostication and to some extent, therapy selection. And increasingly, studies have shown that we can detect those primary abnormalities that we are looking for in FISH in the bone marrow by looking at sequencing in the peripheral blood on the circulating myeloma cells and maybe even circulating tumor DNA. So I think that is the first step in terms of replacing that. The second is in terms of risk stratification. As we already mentioned, the IMWG consensus genomic scoring is the risk stratification tool currently, and we hope that we can get much of this information that we get from FISH from the peripheral blood, in addition to things like beta-2 microglobulin and serum creatinine, which already can be seen from, or is obtained from, peripheral blood. And monitoring for disease response and progression is equally important, as is the case of progression in precursor diseases, and we believe that changes in the tumor markers, particularly the monoclonal protein and the serum free light chain over time, is clearly important for monitoring response as well as risk of progression. Adding to that, we have technology that has made these assessments much more sensitive in the form of mass spectrometry that allows us to detect much lower levels of monoclonal protein and also with more specificity, allowing us to distinguish that from therapeutic monoclonal antibodies that are increasingly being used for treatment of multiple myeloma. And in terms of the MRD testing, you know, we hope that at some point, even if we cannot always rely on the blood, at least the blood can be used as an intermediate test that allows us to reduce the frequency with which we do bone marrow assessment in patients with myeloma.
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