[Multibilly]

New risk of progression study for MGUS and smoldering

by Multibilly on Sat Jan 04, 2014 10:23 am

If you are MGUS or SMM, you might want to read this latest study. Depending on where you are on the risk scale, this paints a more rosy picture for one's risk of progression to symptomatic multiple myeloma than some earlier models. For others, it may not be welcome news.

http://bloodjournal.hematologylibrary.org/content/123/1/4.full.pdf+html

I paraphrased the key results of the one simplistic model without GEP data here:

The first model included only clinical variables: (1) serum M-spike >=30 g/L; (2) bone marrow plasmacytosis >=20%; and (3) age >=65 years. Patients were grouped according to whether they had no risk factors, 1 risk factor, or >=2 risk factors. The clinical model yielded 3 groups with 2-year rates to multiple myeloma requiring treatment of 3%, 14%, and 40%, respectively.

Moderator's Note: The Beacon covered this study in the following news article:
Multiple Myeloma Molecular Subtypes Are Already Present In MGUS And Smoldering Myeloma Patients

[Dianem]

Re: New risk of progression study for MGUS and smoldering

by Dianem on Sat Jan 04, 2014 1:58 pm

Thanks for the link Multibilly. I do not have an involved understanding of multiple myeloma as many on this forum have and may have misunderstood the article. Is the GEP test available now for SMM and MGUS patients so they can learn their risk? Appears based on other data my risk would be referred to as 'intermediate' since my profile is IgG (stays around 1630), trisomic 7, and a first spike 2 years ago of 1.5 (now .9). I appreciate your articles and learn so much from this forum. Diane

[Multibilly]

Re: New risk of progression study for MGUS and smoldering

by Multibilly on Sat Jan 04, 2014 3:56 pm

Regarding the question of whether a GEP is available for SMM and MGUS, the answer is "it depends". There are different GEP tests that are out there and they seem to be specific to given institutions like the Mayo and UAMS, and in general, are only available in a research setting.

In the case of the UAMS GEP (myPRS), you can get it if you go to UAMS. I think any physician can also get access to myPRS if they go to UAMS' GEP development partner, Signal Genetics (www.signalgenetics.com).

But my understanding is that myPRS was developed based on outcomes of the UAMS Total Therapy (TT) protocols. So, I think it may help somebody if they are fans of TT and are going to sign up for TT (I'm not particularly a fan of TT, but that's not the subject of this thread). I'm not familiar with the background of how the Mayo's GEP was developed. The French INSERM group also developed their own unique GEP. I'm sure there are others out there.

But, even if you did have access to GEP and it did prove to be a reliable prognostic tool, the question becomes what would you do with the results as an MGUS or SMM patient? If it told me that I had a x% chance of progressing to symptomatic myeloma versus a lesser y% chance based on other criteria, would one be do anything differently? In my case, I can tell you "no" (at least currently), as I've made a very conscious decision not to pursue early treatment. But I could see some folks signing up for early treatment if they knew there was a strong likelihood that they would later become symptomatic.

[DSMan]

Re: New risk of progression study for MGUS and SMM patients

by DSMan on Sun Jan 05, 2014 2:18 am

Don't some cases of MGUS progress to Lymphoma instead of Myeloma? I assume this study doesn't include these people. So the percentage that progresses to any malignancy would be slightly higher than the study has.

[tanjamead]

Re: New risk of progression study for MGUS and smoldering

by tanjamead on Sat Mar 15, 2014 1:46 pm

I am a patient at UAMS and based on my FISH I would be considered intermediate risk with t(4;14) and del13 but based on the GEP my doc says I'm low risk to progress. Considering I'm only 39 and more of an aggressive approach kind of person, I would probably seek clinical trials for high risk SMM if it were not for having the GEP testing.