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EHA 2025 | The use of CTCs for the staging and prognostic assessment of multiple myeloma
Bruno Paiva, PhD, University of Navarra, Pamplona, Spain, comments on the potential of circulating tumor cells (CTCs) for staging myeloma, highlighting their ability to provide an accurate and minimally invasive assessment of tumor burden and disease dissemination. He emphasizes that CTCs can serve as a powerful prognostic factor, with specific thresholds indicating favorable or unfavorable outcomes, and that a European-level consortium is working to establish clinical guidelines for their use. This interview took place at the 30th Congress of the European Hematology Association (EHA) in Milan, Italy.
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Transcript
Well, the myeloma field is very much excited about the clinical application from the prognostic and staging point of view of circulating tumor cells or easily CTCs. You know that myeloma has always used tumor burden for differential diagnosis across MGUS, smoldering and active myeloma, but never to stage patients. Probably because defining or quantifying tumor burden in a disease like myeloma is not easy, because the bone marrow has a patchy infiltration, there may be extramedullary disease, and at the end of the day a single aspirate may not be fully representative of the entire tumor burden...
Well, the myeloma field is very much excited about the clinical application from the prognostic and staging point of view of circulating tumor cells or easily CTCs. You know that myeloma has always used tumor burden for differential diagnosis across MGUS, smoldering and active myeloma, but never to stage patients. Probably because defining or quantifying tumor burden in a disease like myeloma is not easy, because the bone marrow has a patchy infiltration, there may be extramedullary disease, and at the end of the day a single aspirate may not be fully representative of the entire tumor burden. Now, we believe that when we look and we quantify the number of CTCs, we have an exquisite marker of the entire tumor burden in the patient’s body, but not only that, because from the biological point of view, the presence of CTCs in blood is a surrogate of proliferation in the marrow and the measurement in real time of the extent of disease dissemination that is happening in this patient and it’s why study after study CTCs has emerged as a powerful prognostic factor. Now what was missing was to have guidance, a cut-off on how to use it in clinical practice and that’s what we try to achieve in this consortium at the European level, this meta-analysis with a very large number of patients that will be presented by my colleague Luca Bertamini on Friday afternoon. And in this unprecedentedly large meta-analysis we confirm the independent prognostic value of CTCs. It is complementary to other staging risk models and you can use CTCs very easily. Less than 0.02% favorable prognosis, higher than 0.02% worse outcome. If more than 2%, then it’s a patient with myeloma, almost with a hidden plasma cell leukemia. That patient may not have primary plasma cell leukemia by conventional criteria, but will behave as such, is a high-risk patient and probably should be treated differently.
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