ASH 2024 | Improved risk stratification of SMM using trajectory data in the PANGEA 2.0 model

So the whole idea of how can I define what is high-risk smoldering myeloma? And this is a real question because many of our patients may actually have smoldering myeloma, but they will never progress in their lifetime, more MGUS-like. And there are patients who are actually myeloma, and you just haven’t seen the bone lesion or the kidney failure. And you want to prevent that. You want to really predict who will develop myeloma in their lifetime.

We currently use criteria called the 20/2/20 and they are very good criteria and in fact in our data we further confirm that 20/2/20 is very strong in our patients. But many of us will see patients having their M spike go up or having their light chain go up, what we call evolving criteria or trajectory increases and we want to be able to use that data to predict because we’re using it in the clinic already but we don’t have numbers. 

So now we have PANGEA 2.0 which is basically using the trajectory or the evolving criteria of your M-spike, of your light chain, the decrease in your hemoglobin, the change in your creatinine and your age, and using that as a model that can really predict for you a little bit earlier whether you will progress to myeloma or not. It builds on 20/2/20. It’s actually stronger in the C statistics than 20/2/20, and we were able to really have everyone participate on it. So we had our own over 1,000 patients at Dana-Farber, but we had people from Germany, France, UK, Greece, everyone really came together to say, let’s put our data together, over 2,000 participants to really open that so that it is the next model that we can use in the future, even building up on 20/2/20.

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