COMy 2026 | Improving risk stratification & early treatment strategies in myeloma and smoldering myeloma

We are in a revolutionary era in multiple myeloma according to many treatments and combinations that have been approved and reimbursed in the last years. However, I think we have always to take care about the correct proliferations of our patients because I think that we have to improve the stratification and risk stratification of patients affected, not only by multiple myeloma, but also by smoldering myeloma in order to understand which is the real situation. In my institution, we are combining in our everyday practice, according to an internal trial, full body MRI 3-Tesla together with PET-CT. And the combination of these two methods in about half of the patients gives an improvement of the diagnostic and sometimes can change the destiny of our patients. So first, in terms of imaging, we have to improve what we offer to our patients, also in monitoring and in suspicion of relapse. In terms of molecular stratification, we are performing genomic profiling in SKY92 to every patient in order to detect biomarkers because we think that the new era which we will have in multiple myeloma will be to optimize the drugs that we have available and potentially to go in a targeted therapy in multiple myeloma so the idea to detect the biomarkers of a response or biomarkers of refractoriness is something that will help us to optimize the use of drugs and combinations. The idea of in some way collecting this data from molecular from metabolomics from radiologic assays and to use through artificial intelligence inside in a big evaluation maybe can take us to potential new prognostic scores for our patients. And we are in some way working in this sense also for the pre-myeloma status in order to better understand who is at risk today and who is the patient that should be treated instead of watching and waiting. I think that the new era will be also to concentrate our efforts on pre-myeloma status. We have seen that daratumumab, according to AQUILA trial, has been approved, but many new combinations are arriving. Isa-len-dex ITHACA trial was another exciting opportunity we are strongly waiting for data from this trial and I think that also specific antibodies particularly linvoseltamab and elranatamab will play an incredible role in smoldering myeloma management. This is to say that we will start to treat myeloma not only in a frontline setting but also at time zero. The idea to treat smoldering myeloma is something that excites me and my institution and also patients that have in some way the awareness about their status. They want absolutely to be treated if they are at high risk.

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