“Increasing numbers of clinical trials now use prognostic markers to stratify the patients, and use these markers to determine patients’ eligibility for the study,” Dr Fung said. “Based on the prognostic markers, we may offer different induction, consolidation, and maintenance to our patients. This can be used to predict response and development of a risk-adapted approach.”
For example, Dr Fung said that some oncologists tend to use a proteome inhibitor for both induction and maintenance for patients with translocation (4;14), and that they will consider tandem autologous stem cell transplant for patients with unfavorable cytogenetics.
“In fact, we use cytogenetics by FISH mostly for risk stratification, though some may use gene expression profile,” Dr Fung said. “The prognostic markers may help to elect patients for a more aggressive treatment approach, but equally important is avoiding overtreatment.”
The use of these risk-adapted strategies is still new in the myeloma arena, and clinical trials will test the utility of using these approaches. If validated, the use of risk-adapted approaches would be an important first step toward more individualized therapy for patients with myeloma.
Future of the Individualized Approach
Despite the advances seen in prognostic markers for patients with myeloma, use of both newer and traditional markers are still needed to determine the most effective treatment plan for patients with newly diagnosed disease.
“New biological markers, such as mutational profile, are evolving, and may take us another step towards precision therapy, specifically when a targetable mutation is identified,” Dr Fung said. “Clinical factors such as performance status, age, and co-morbidity are, however, very important prognostic and predictive factors to determine the best available treatment for our patients.”
As new treatments for myeloma emerge, the value of available prognostic markers will require constant re-evaluation.
Disclosures: the author has no relevant relationships to report.
- Smith D, Yong K. Advances in understanding prognosis in myeloma. Br J Haematol. 2016 Sep 8. doi: 10.1111/bjh.14304 [Epub ahead of print]
- Auner HW, Garderet L, Kroger N. Autologous hematopoietic cell transplantation in elderly patients with multiple myeloma. Br J Haematol. 2015;171:453-462.
- Paiva B, Vidriales MB, Montalban M, et al. Multiparameter flow cytometry evaluation of plasma cell DNA content and proliferation in 595 transplant-eligible patients with myeloma included in the Spanish GEM2000 and GEM2005 < 65y trials. Am J Pathol. 2012;181(5):1870-8.
- Avet-Loiseau H, Attal M, Moreau P, et al. Genetic abnormalities and survival in multiple myeloma: the experience of the Intergroupe Francophone du Myelome. Blood. 2007;109:3489-3495.
- Boyd KD, Ross FM, Chiecchio L, et al. A novel prognostic model in myeloma based on co-segregating adverse FISH lesions and the ISS: analysis of patients treated in the MRC Myeloma IX trial. Leukemia. 2012;26:349-355.
- Bergsagel PL, Mateos MV, Gutierrez NC, Rajkumar SV, San Miguel JF. Improving overall survival and overcoming adverse prognosis in the treatment of cytogenetically high-risk multiple myeloma. Blood. 2013;121:884-892.