Dr Krishnan on Patient Characteristics Associated With Early Relapse in Multiple Myeloma

Amrita Krishnan, MD, executive medical director, Hematology, City of Hope Orange County; director, the Judy and Bernard Briskin Multiple Myeloma Center; professor, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, discusses the characteristics and factors associated with a higher risk of early relapse for patients with multiple myeloma, highlighting how this may impact the use of BCMA-targeted therapies in earlier lines.

Several factors associated with a higher risk of early relapse have been identified for patients with myeloma, Krishnan begins, including disease-related factors such as advanced International Staging System (ISS) stage and high-risk cytogenetics. These static markers are established at the time of diagnosis and can be predictive of disease progression and patient prognosis, she expands.

Beyond these, dynamic risk factors often emerge during treatment and follow-up, Krishnan continues. For example, a suboptimal response to initial treatment or an early relapse after initial therapy are significant indicators of higher risk, she says. These factors suggest that the myeloma is more aggressive or less responsive to standard therapies, necessitating more intensive monitoring and potentially different therapeutic strategies.

Despite the identification of these risk factors, current models for predicting relapse and disease progression remain insufficient, Krishnan notes. As the field advances, and the use of T-cell engaging therapies such as bispecific antibodies and CAR T-cell products becomes more prevalent, a deeper understanding of the tumor immune environment will be necessary, she emphasizes.

Overall, significant strides have been made in identifying static and dynamic risk factors in multiple myeloma. However, there is a pressing need to integrate immune profiling into clinical practice, Krishnan states. Understanding and leveraging knowledge of the immune environment could enhance the precision of risk stratification and treatment selection, ultimately improving outcomes for patients with multiple myeloma, she concludes.