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Risk Assessment for Myeloma

Panelists: A. Keith Stewart, MB, ChB, Mayo Clinic; Cristina Gasparetto, MD, Duke University Medical Center; Parameswaran Hari, MD, MRCP, MS, Medical College of Wisconsin; Robert Orlowski, MD, PhD, MD Anderson Cancer Center; Noopur Suresh Raje, MD, Massachusetts General Hospital
Published: Monday, Jan 22, 2018



Transcript: 

A. Keith Stewart, MB, ChB: Hello, and thank you for joining this OncLive® Peer Exchange® titled “Multiple Myeloma: Emerging Concepts in Management.” Life expectancy for patients with multiple myeloma has increased significantly over the past 20 years. Additionally, we continue to evaluate novel therapies to achieve deeper responses and improve outcomes for patients. In this OncLive® Peer Exchange® panel discussion, my colleagues and I will provide our personal perspectives on the new research, new combinations, and new agents available to us. We’ll review the data from ASH 2017 and the impact on what has been presented on how we treat our patients with symptomatic disease.

I’m Dr. Keith Stewart, the Vasek and Anna Maria Polak professor of cancer research at the Mayo Clinic. Participating today on our distinguished panel are Dr. Cristina Gasparetto, an associate professor of medicine and director of the myeloma program at Duke University Medical Center in Durham, North Carolina; Dr. Hari, professor of hematology at the Medical College of Wisconsin in Milwaukee, Wisconsin; Dr. Robert Orlowski, chairman of the Department of Lymphoma and Myeloma and director of Myeloma and professor of medicine at MD Anderson Cancer Center in Houston, Texas; and Dr. Noopur Raje, professor of medicine at Harvard Medical School and director of the Multiple Myeloma Program at Massachusetts General Hospital in Boston, Massachusetts. Thank you so much for joining us. Let’s begin.

Bob, I’d like to start with you. Nowadays, it has become clear that there are many different types of multiple myeloma with different variable outcomes. I was interested, to start our discussion, in how you work up a patient at MD Anderson with respect to risk stratification.

Robert Orlowski, MD, PhD: Great question, Keith, and thanks for having me on the program by the way. Definitely fluorescence in situ hybridization, or FISH, studies on the bone marrow are a standard of care now, especially because you need the results from the FISH to do the staging. Because the revised ISS includes either deletion 17p or translocation 4;14 as one of the factors that could flip the stage upward. And you also have to do a lactate dehydrogenase level. And then, gene expression profiling can be very helpful as well because there are some patients, for example, from older data with deletion 17p, who you would think would be high risk, but if they have a good risk profile by the GEP (gene expression profiling) data, that can actually indicate that their prognosis is better. So, the benefits of doing this assessment are, number 1, you get a better analysis of the stage and, number 2, you can provide the patient with a better estimate of their prognosis. Although right now we’re not yet at the point where we routinely do different induction therapy based on the risk, many people now will do different maintenance therapies, which we hopefully will get to later in the program. And there are now some risk-adapted studies that are underway as well.

A. Keith Stewart, MB, ChB: Let me ask the rest of the panel. Do you treat the patients differently based on their genetic risk score or do you feel it’s just interesting from the prognostic point of view? Hari, what do you think?

Parameswaran Hari, MD, MRCP, MS: I totally agree with what Dr. Orlowski just said, that induction doesn’t really matter at this point based on risk. I tend to think in my own mind that a younger person, especially with a high-risk profile, needs to get to a molecular MRD-negative stage. I think the attainment of an MRD-negative state has been shown to be particularly significant for those people. So, in that way, I try to tailor treatment towards getting there as quickly as possible for those people.

Transcript Edited for Clarity 

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Transcript: 

A. Keith Stewart, MB, ChB: Hello, and thank you for joining this OncLive® Peer Exchange® titled “Multiple Myeloma: Emerging Concepts in Management.” Life expectancy for patients with multiple myeloma has increased significantly over the past 20 years. Additionally, we continue to evaluate novel therapies to achieve deeper responses and improve outcomes for patients. In this OncLive® Peer Exchange® panel discussion, my colleagues and I will provide our personal perspectives on the new research, new combinations, and new agents available to us. We’ll review the data from ASH 2017 and the impact on what has been presented on how we treat our patients with symptomatic disease.

I’m Dr. Keith Stewart, the Vasek and Anna Maria Polak professor of cancer research at the Mayo Clinic. Participating today on our distinguished panel are Dr. Cristina Gasparetto, an associate professor of medicine and director of the myeloma program at Duke University Medical Center in Durham, North Carolina; Dr. Hari, professor of hematology at the Medical College of Wisconsin in Milwaukee, Wisconsin; Dr. Robert Orlowski, chairman of the Department of Lymphoma and Myeloma and director of Myeloma and professor of medicine at MD Anderson Cancer Center in Houston, Texas; and Dr. Noopur Raje, professor of medicine at Harvard Medical School and director of the Multiple Myeloma Program at Massachusetts General Hospital in Boston, Massachusetts. Thank you so much for joining us. Let’s begin.

Bob, I’d like to start with you. Nowadays, it has become clear that there are many different types of multiple myeloma with different variable outcomes. I was interested, to start our discussion, in how you work up a patient at MD Anderson with respect to risk stratification.

Robert Orlowski, MD, PhD: Great question, Keith, and thanks for having me on the program by the way. Definitely fluorescence in situ hybridization, or FISH, studies on the bone marrow are a standard of care now, especially because you need the results from the FISH to do the staging. Because the revised ISS includes either deletion 17p or translocation 4;14 as one of the factors that could flip the stage upward. And you also have to do a lactate dehydrogenase level. And then, gene expression profiling can be very helpful as well because there are some patients, for example, from older data with deletion 17p, who you would think would be high risk, but if they have a good risk profile by the GEP (gene expression profiling) data, that can actually indicate that their prognosis is better. So, the benefits of doing this assessment are, number 1, you get a better analysis of the stage and, number 2, you can provide the patient with a better estimate of their prognosis. Although right now we’re not yet at the point where we routinely do different induction therapy based on the risk, many people now will do different maintenance therapies, which we hopefully will get to later in the program. And there are now some risk-adapted studies that are underway as well.

A. Keith Stewart, MB, ChB: Let me ask the rest of the panel. Do you treat the patients differently based on their genetic risk score or do you feel it’s just interesting from the prognostic point of view? Hari, what do you think?

Parameswaran Hari, MD, MRCP, MS: I totally agree with what Dr. Orlowski just said, that induction doesn’t really matter at this point based on risk. I tend to think in my own mind that a younger person, especially with a high-risk profile, needs to get to a molecular MRD-negative stage. I think the attainment of an MRD-negative state has been shown to be particularly significant for those people. So, in that way, I try to tailor treatment towards getting there as quickly as possible for those people.

Transcript Edited for Clarity 
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