IMS 2023 | Defining and treating high-risk multiple myeloma
Frits van Rhee, MD, PhD, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, discusses the use of gene expression profiling (GEP) to define high-risk multiple myeloma (HRMM). Prof. van Rhee explains how there is still a significant unmet need in this patient population, despite improvements in treatment regimens, and concludes by discussing the need to conduct clinical trials to evaluate the efficacy of bispecific antibodies and CAR-T cells in these patients. This interview took place at the 20th International Myeloma Society (IMS) Annual Meeting, held in Athens, Greece.
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Transcript (edited for clarity)
We have had an interest in high-risk myeloma for a very long time. In fact, we were the first group to develop treatment strategies based on whether a patient was high-risk or not. We initiated such a trial in 2019, so we had different trials for high-risk and low-risk patients. Our definition of high-risk was by gene expression profiling, the so-called ’70-gene score’, and we found that the patients with good-risk or standard-risk myeloma do extremely well...
We have had an interest in high-risk myeloma for a very long time. In fact, we were the first group to develop treatment strategies based on whether a patient was high-risk or not. We initiated such a trial in 2019, so we had different trials for high-risk and low-risk patients. Our definition of high-risk was by gene expression profiling, the so-called ’70-gene score’, and we found that the patients with good-risk or standard-risk myeloma do extremely well. Conversely, the patients with high-risk myeloma, even with an extensive treatment program, using tandem autologous stem cell transplantation and three drugs as maintenance for three years, still have a poor outcome. Our new trials show some improvement with the addition of daratumumab for high-risk. But overall, high-risk as we define it by gene expression profiling, still remains a significant unmet need. What we so far have not answered is the question of whether the new bispecific antibody therapies and CAR-T cell therapies will make a major impact on the outcome of these patients. We would like to think that they do – we are in the process of developing clinical trials for this high-risk group of patients. But I think the future will have to answer that question, whether upfront novel immune therapies for high-risk myeloma will improve outcomes.
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