The 19th International Myeloma Society Annual Meeting hosted a session dedicated to High-Risk Myeloma for its attendance from around the globe. Dr. Hervé Avet-Loiseau moderated the session, and after his opening remarks, Dr. Jill Corre and Dr. Mehmet Samur discussed current risk stratification systems and factors contributing to disease progression based on recent literature and novel data from their research. Dr. Corre discussed the importance of cytogenetic assessment and focused on chromosome 1 abnormalities in patient outcomes. She elaborated on her case with the cumulative impact of risk factors and modified definitions of del17p clonality cut-off, TP53 mutations, and t(4;14) MM. Dr. Samur expanded several points presented by Dr. Corre by adding data from new genomic studies where accumulated DNA damage contributes to risk stratification. He further showed a new t(4;14) risk model developed based on genomic data and later focused on how risk factors evolve from diagnosis to later stages using single-cell DNA sequencing data.
These two presentations were then followed by Dr. Shaji Kumar and Dr. Ajai Chari‘s presentation on optimal therapy and functional high-risk in MM. Dr. Kumar started his talk by discussing risk-adapted therapy for high-risk patients. He then discussed the data from Forte, GRIFFIN, OPTIMUM, CONCEPT, and EMN trials to discuss the role of various combination therapies and transplant on high-risk MM. He finished his talk by explaining the role of achieving MRD- in high-risk patients. Dr. Chari completed the first part of the session by highlighting the importance of continuous risk assessment. He underscored that post-treatment risk factors carry equal value to the diagnostic characteristics. He further elaborated that >20% of patients are potential functional high-risk cases, and future studies should utilize novel approaches to add functional risk stratifications in phase III studies.
In the second part of the session Dr. Travis Johnson, Dr. Romain Lannes, Dr. Cyrille Touzeau, and Dr. Mortiz Binder presented their abstracts. While Drs. Johnson and Lannes focused on clonal changes in 1q myeloma, the role of Dara KRd on high-risk patients enrolled in IFM2018-04 Phase II study was presented by Dr. Touzeau and Dr. Binder focused on stroma-MM cell interaction. Dr. Wee Joo Chng subsequently discussed the importance of presented works in the light of existing literature and highlighted the role of single-cell sequencing, the interaction between microenvironment and MM cells, and the need for new clinical trial designs that would help high-risk patients. Dr. Martin Kaiser‘s presentation completed the session and explained the unmet needs of high-risk MM. In his closing remarks, Dr. Kaiser highlighted longitudinal testing, developing new biomarkers to stratify patients, and integrating such information with MRD and imaging. He further elaborated on the need for high-quality evidence and extensive collaborations to produce the data.
