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TAXIARCHIS KOURELIS: Myeloma is not one disease. Myeloma is several different diseases. You can have a spectrum of myelomas from people that survive the disease for decades. Some of them even get cured. Then, you have some people with very, very aggressive disease. And individualized approaches are not only disease related. They're also patient related. How aggressive is my myeloma? Do I have high risk? Or do I have non-high risk myeloma? Or what stage is my myeloma?
And you can calculate these things using either a combination of blood tests as well as molecular studies. MRD, or minimal residual disease, is a laboratory methodology used to identify even tiny amounts of residual myeloma cells left in your bone marrow after therapy. It's important, because several studies are now showing that patients that achieve that MRD negativity have better outcomes. The more we know about the disease, I think the more we're going to change management based on MRD as an endpoint.
S. VINCENT RAJKUMAR: Myeloma is unique, because it is a clinical pathologic diagnosis. You need both the pathologist's opinion as well as a clinician's opinion to make the diagnosis. We see errors in diagnosis made all the time, because there are asymptomatic conditions which are pre-malignant that can be very difficult to distinguish from multiple myeloma by just looking at the bone marrow or lab tests.
Currently, we consider patients with trisomies 11, 14 translocation and 6, 14 translocation to have standard risk multiple myeloma. And we consider patients with deletion 17p 1q gain, 14, 20, 14, 16, and 4, 14 translocations to have high risk myeloma. And then we outline approaches to treatment, which are different for each subgroup.
WILSON I. GONSALVES: Novel treatments such as proteasome inhibitors, immunomodulators, and other small molecules, and then immunotherapies, harnessing the power of your body's own immune system, trying to stimulate it so that it can see the myeloma and actually act on it.
S. VINCENT RAJKUMAR: These T cells are trained to fight the myeloma. CAR T cell therapy is the way of the future. We have clinical trials available for every stage of myeloma.
WILSON I. GONSALVES: The value of a second opinion for a multiple myeloma patient, even though they have been started on appropriate standard of care therapy, is really important to understand the lay of the land of what is that next generation. What is the therapy going to look like in the future? Our goal at the end of the day is, how can we cure this disease, or how can we make sure that people lead a normal life span with this disease? And as long as that's still the goal, we always need to keep improving on our treatments. And clinical trials really allow us to do that in a scientific fashion, as well as provide patients with access to some of these novel treatments early on.
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