iwHRMM 2025 | How gene expression profiling may be used to individualize therapy decisions in myeloma

I think myeloma is undergoing a large change at the moment in that we have very effective therapies, which in the first instance, fortunately, can bring nearly all of our patients into or their disease into remission. That’s great. We didn’t have that 20 years ago. But it then brings up these questions about how to manage the patient from there onwards. At the moment, all the treatments that we have available have been developed as non-stop ongoing therapies. And I think rightly so from a patient perspective. Some patients are now on treatment for 10 years or longer. Ongoing therapies, they ask for treatment holidays. Now, the question is, how do we identify in a disease that is so different from patient to patient who can safely go, for example, on a treatment holiday or who might need rather more treatment and will benefit from not stopping therapy? And that’s where the genetics come in because that’s our one opportunity at diagnosis when the disease is newly diagnosed that we get a pure sample of the tumor. It’s actually a big advantage in myeloma that we can get a very pure tumor material from the bone marrow. And that is our advantage. That’s what we have to really work on to get that complete in every patient because it often gives us the information that we then need three, four, five years later when a patient often asks about, should I go on to a treatment holiday at that point? And there would be patients that have an absence of genetic and gene expression markers where I think the data is increasingly looking that it will be pretty safe to do a treatment holiday. But there will be the other type of group, of course, patients that have high-risk disease, where a continuation of treatment has been very clearly shown in clinical trials to have not only the patient stay longer in remission, but live longer as well. So actually, for these patients, we can really individualize the recommendation that we make. Ultimately, of course, it always has to be a joint decision-making process, but I think many patients value it very highly if we can give them a better steer and better information as to how to take the treatment forward.

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