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iwHRMM 2025 | The value of extensive profiling in single-arm trials for high-risk myeloma
Martin Kaiser, MD, FRCP, FRCPath, The Royal Marsden NHS Foundation Trust, London, UK, discusses the importance of comprehensive profiling using genetics, gene expression, and potentially imaging, in patients with high-risk multiple myeloma. Dr Kaiser highlights that these technologies enable the characterization of factors that cannot be identified through clinical parameters alone, and allow for more accurate comparisons of outcomes within clinical trials and with external datasets. This interview took place at the 2nd International Workshop on High-Risk Multiple Myeloma (iwHRMM 2025), held in Charleston, SC.
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Transcript
The comprehensive profiling by genetics and gene expression and maybe also imaging in the future is giving us a very powerful tool at hand because it can tell us really the majority of factors that we know are prognostically associated and cannot be identified by other means, just clinical parameters such as age or frailty, which of course play a role as well. And definitely in older or elderly patients, they play a bigger role...
The comprehensive profiling by genetics and gene expression and maybe also imaging in the future is giving us a very powerful tool at hand because it can tell us really the majority of factors that we know are prognostically associated and cannot be identified by other means, just clinical parameters such as age or frailty, which of course play a role as well. And definitely in older or elderly patients, they play a bigger role. But in a younger patient, many of these factors are hidden. So we need technologies. We need diagnostic technology to actually understand and chart and really characterize these factors. So we’re now really fortunately having tools at hand that we did not have before in terms of clinically approved genetic tests, gene expression tests. I would actually count imaging into this as well, although it’s in yet another field and another whole topic to discuss, that really allow us to capture nearly all the prognostic factors that we know. Now, if we do have that characterization within a clinical trial, we can actually compare the outcome much better to an external data set if that external data set was profiled with exactly the same tests, with the same technology. That’s why it’s important to have standards, to have quality controls, to have a technological similarity in what we assay, because suddenly then trial results that we think were just playing a role in time once can actually play a role three or four years down the line by comparing them against an external data set in a much more clever fashion than just looking at the outcome across all patients that went into the trial. We can then really look at subgroups of the patients and really find a much more conclusive answer to who did benefit from the new treatment. Was it just a subgroup? Was it everyone where there’s some patients that are remaining with a really high unmet need? And that’s helping us then to design the next generation of trials because these patients, of course, with the highest unmet need, they are probably willing, but also we are knowing then at that point that maybe our risk-benefit balance needs to be shifted as opposed to a patient where we see a massive benefit already from the treatments that we have available at the moment.
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