Good morning, myeloma world.

We hope your weekend has gotten off to a good start. We've been looking over the latest myeloma-related research since the last edition of Myeloma Morning, and it appears we have just a short list of new material to discuss today.

In fact, we will be focusing today on just two new research articles.

The first is from a team of U.S. researchers, most of whom are based at the Uni­versity of Arkansas for Medical Sciences (UAMS). The study looks at a novel way of predicting how likely an MGUS or smoldering multiple myeloma patient is to progress to multiple myeloma re­quir­ing treat­ment (full text: html, pdf).

The Arkansas study involves patients who were enrolled in an observational clinical trial known as SWOG S0120. To participate in the trial, patients had to have “asymptomatic multiple myeloma,” which in most cases meant either monoclonal gammopathy of undetermined significance (MGUS) or smoldering multiple myeloma. Trial participants had various laboratory tests and different types of imaging conducted during their participation in the trial, but their disease was not actively treated.

A total of 110 of the trial participants had asymptomatic multiple myeloma according to the revised diagnostic criteria for multiple myeloma and also had testing done that make their results relevant to this study.

In particular, the 110 participants had bone marrow cells evaluated at the time of diagnosis in a way that allowed for the calculation of two measures, known as CIg and LCR%. CIg measures the production of immunoglobulin by plasma cells in the patient's bone marrow. LCR% is the percent of plasma cells in the marrow which produce only light chains; it is considered a measure of “tumor burden,” or how extensive a patient's disease has spread throughout their body.

The Arkansas researchers found that a patient's M-spike, CIg, and LCR% were very good at predicting whether the patient's MGUS or smoldering myeloma would progress within two years to a point where it was necessary to treat the disease. The researchers calculated cutoff values for each of the three measures and used them to divide the patients into three groups:

• Those with a low risk (4 percent likelihood) of progressing within two years to disease requiring treatment
• Those with a medium risk (30 percent likelihood) of progression within two years
• Those with a high risk (82 percent likelihood) of progression within two years.

The second new article we'll look at today is from a group of researchers in Marseille, France. They have published a study looking at long-term data on myeloma patients with impaired kidney function (full text: html, pdf).

The study authors compiled data on 135 multiple myeloma patients who were admitted to a kidney care unit in Marseille in the period between 1999 and 2014. The researchers break this time period into two parts – 1999-2007 and 2008-2014 – based on the fact that, in 2007, Velcade (bortezomib) was approved in France for use as first-line therapy in myeloma patients. Velcade is often recommended for the treatment of newly diagnosed myeloma patients with kidney damage.

Of the myeloma patients in the early period who were dialysis dependent when they came to the kidney care unit, only about 20 percent eventually achieved dialysis independence. In comparison, in the second period, over 50 percent of the patients who were dialysis dependent eventually achieved dialysis independence.

The authors also split patients into a different set of two groups, based on the treatment they received after admission to the kidney care unit. They created one group that was treated with Velcade-containing treat­ment regimens, and a second group that was treated with other regimens. The difference between the groups in the percent of patients achieving dialysis independence was similar to what was seen between the groups created based on year of treatment. Patients treated with Velcade-containing regimens had a much higher rate of dialysis independence.

The French study comes at an interesting time, given that earlier this month the International Myeloma Working Group published its recommendations for the diagnosis and management of myeloma-related kidney impairment (abstract). Those recommendations came out prior to the launch of Myeloma Morning, so we have not discussed them here. However, the recommendations were summarized and discussed a bit in the Beacon forum, for those who may be interested.

Once again, we don't have any new myeloma-related business news to report. There has been, however, the usual level of activity for this time of the week in the Beacon's forum.

• John from Tampa, Florida, has introduced himself to everyone in the forum; he was diagnosed with multiple myeloma in 2013
• Debbie continues to be a real trooper and has posted a couple additional updates regarding her ongoing stem cell transplant; today is her Day +8 (this post includes a photo!)
• Amber's father has multiple myeloma, and she wants to know if she should be concerned because several of her father's test results have been on the high side recently.
• Forum regular Cheryl G has “humbly” suggested that perhaps it would be wise to avoid using the phrase “standard of care” when responding to questions in the forum; what do you think?

New myeloma-related research articles

1. Aguiar, P. M. et al., “Systematic review of the economic evaluations of novel therapeutic agents in multiple myeloma: what is the reporting quality?” in the Journal of Clinical and Therapeutics, March 23, 2016 (abstract)
2. Laforet, M. et al., “Evolution in the treatment of multiple myeloma and impact on dialysis independence: data from a French cohort from 1999 to 2014” in Blood Cancer Journal, March 25, 2016 (full text)
3. Papanikolaou, X. et al., “Flow cytometry defined cytoplasmic immunoglobulin index is a major prognostic factor for progression of asymptomatic monoclonal gammopathies to multiple myeloma (subset analysis of SWOG S0120)” in Blood Cancer Journal, March 25, 2016 (full text)
4. Wang, X.-G. et al., “Identification potential biomarkers and therapeutic agents in multiple myeloma based on bioinformatics analysis” in European Review for Medical and Pharmacological Sciences, March 2016 (PDF)