Dr Usmani on Identifying High-Risk Patients With Multiple Myeloma

Saad Z. Usmani, MD, MBA, FACP, hematologic oncologist, chief, Myeloma Service, Memorial Sloan Kettering Cancer Center, discusses methods for identifying patients with high-risk multiple myeloma and notable disease characteristics in this population.

At the 2023 SOHO Annual Meeting, Usmani shared a presentation on the frontline treatment of patients with newly diagnosed, high-risk multiple myeloma. Because of the risk of progression within the first 2 years of a patient’s diagnosis, it is vital to pick the best treatment approach with the highest likelihood of response within the first year of diagnosis, he explains. This is best done by understanding disease biology, disease burden, patient characteristics, and patient preferences. However, progression can occur even when treating a patient with the appropriate induction, transplant, or consolidation maintenance therapies, Usmani notes, adding that factors that are associated with high-risk disease will likely change as newer treatment strategies are incorporated into the frontline setting.

There are certain karyotypic and genetic abnormalities, as well as certain clinical features, that portend a high risk of multiple myeloma coming back or progressing in this patient population, he continues. For example, there are certain translocations that can indicate a high-risk patient. It is also possible to identify a high-risk patient by the number of extra copies of certain chromosomes that they have, as 4 or more copies in one patient indicate that patient has high-risk disease, Usmani explains. Furthermore, the presence of extramedullary myeloma, the presence of circulating plasma cells, and the presence of deletion 17p or P53 mutations are all also indicators of high-risk disease, and if a patient presented with such, they would be considered high risk.

Notably, RAS mutations are another indicator of high-risk disease, Usmani says. Looking to the future, some other indicators of high-risk multiple myeloma are emerging, such as deletion 1p32, he concludes.

Clinicians referring a patient to MSK can do so by visiting msk.org/refer, emailing referapatient@mskcc.org, or by calling 833-315-2722.