Translating Data: Risk-Profiling Smoldering Multiple Myeloma

In the first part of Multiple Myeloma Today’s roundtable series on Translating Data from research presented at the American Society of Hematology’s 2021 Annual Meeting and Exposition (ASH 2021), moderator Dr. Saad Usmani and Dr. Malin Hultcrantz discuss risk scoring and risk profiling in patients with smoldering multiple myeloma.

Malin Hultcrantz: One of the things with the early precursor disease and smoldering that I wanted to highlight was this concept of the risk scoring and the risk profiling of smoldering. Right now all the risk profiling basically around us and smoldering, is based on the burden of disease. What is the M-spike? What is the relation ratio? How many plasma cells are there? So it’s basically just looking at what are the labs and how many cells are there. There’s data now coming out looking more on the biology of this and having a more biological base for doing these risk scorings.

So — summarize this in a very nice fashion, where they have their — genome sequencing for pairs of smoldering those that have progressed and those that have not progressed; And those that have progressed, they do have a different type of genomic landscape. So they have a much more complex genomic landscape. They have more hotspot mutations. They have more deletions. They have more complex structural variations, so the chromothripsis and ChromoPlexes; and also they have the difference in the mutational signatures which are much higher below the APOBEC signatures.

So, basically this is right now on the research side. But this would be very important to be able to put this into a clinical test and do this type of clinical profiling because then we can risk profile patients much more on the biology. So instead of moving from MGUS to smoldering to myeloma, we can have kind of non-progressors and high risk for progression. And those patients in the next step would be those that we could have early interventions, early trials. So I think that was some of the very interesting updates that came out of that.