ASH 2021 | The impact of screening for myeloma precursor conditions
The PROMISE study (NCT03689595) screened high-risk individuals for precursor conditions to myeloma and continues to monitor them, hoping to identify risk factors for progression to symptomatic multiple myeloma. Results reported at ASH 2021 demonstrated that screening in this high-risk population identified a high prevalence of monoclonal gammopathy of undetermined significance (MGUS), as well as the newly defined monoclonal gammopathy of indeterminate potential (MGIP). Irene Ghobrial, MD, Dana-Farber Cancer Institute, Boston, MA, discusses the questions raised by the findings and the impact of screening these individuals, both clinically and psychologically. This interview took place at the 63rd ASH Annual Meeting and Exposition congress in Atlanta, GA.
Transcript (edited for clarity)
Asking the question of, “Should I screen and will that cause problems, especially that many of the patients are not being treated to date?” I would say, let’s go backwards and say, “Every single patient who has myeloma today who comes in and they’re symptomatic, they must have had an earlier MGUS and smoldering myeloma.” The current standard of care right now for all cancers is you wait until you have symptoms...
Asking the question of, “Should I screen and will that cause problems, especially that many of the patients are not being treated to date?” I would say, let’s go backwards and say, “Every single patient who has myeloma today who comes in and they’re symptomatic, they must have had an earlier MGUS and smoldering myeloma.” The current standard of care right now for all cancers is you wait until you have symptoms. You go see your doctor, and then you treat it. That’s being reactive.
What if we become proactive? What if we change completely the game for cancer? Now, we can be proactive and find it. Indeed, we know that cancer screening saves lives. We do it for mammography. We do it for colonoscopy. I would say a blood sample is probably easier than doing all of those. The question is, will you do something about it if you find it early?
The first thing is we found that there was no difference in anxiety levels. We had an anxiety questionnaire for all of the people on the PROMISE study. The second thing is, for all our patients who are screened positive, we actually have a whole cohort that we ask them to see one of our hematologists or oncologists. They get their routine labs checked every year. They have a close follow-up. We know now from the iSTOP study, where they randomized patients, that, indeed, if you identify MGUS early, you may also identify smoldering myeloma early.
Indeed, we found in many of our patients smoldering myeloma and, in a couple of cases, actually overt myeloma that we found it. When we told them, “Go get a PET/CT scan,” they had lesions. You can find myeloma early and potentially can treat it early. The second important thing is there are data and studies now that have shown already that you can treat smoldering myeloma and potentially change the survival and change the progression-free survival, at least prevent CRAB criteria. The argument is detect it early, potentially identify who’s at risk of developing myeloma, and then treat those people early.
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