The ASCO Post invited myeloma expert Philip L. McCarthy, MD, Director of the Transplant and Cellular Therapy Program at Roswell Park Comprehensive Cancer Center, Buffalo, New York, to comment on the trials evaluating early detection of myeloma at the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition.1,2
“These studies are the result of tremendous efforts by our colleagues in the United States and Iceland. Identifying and intervening with therapy for patients with monoclonal gammopathy at high risk for disease progression and end-organ damage may become standard in the near future,” said Dr. McCarthy, who pointed out that monoclonal gammopathy of undetermined significance (MGUS) can also be associated with osteoporosis and fractures, chronic inflammatory demyelinating neuropathy and autonomic neuropathy.3 “Detecting MGUS and biomarkers for risk may identify patients for more detailed screening, follow-up, and treatment to prevent bone fractures.”
Philip L. McCarthy, MD
Further highlighting the value of early detection, he noted that another early sign of disease—clonal hematopoiesis of indeterminate potential (CHIP)—is not only associated with an increased risk of hematologic cancers and cardiovascular disease, but perhaps a reduced risk of Alzheimer’s disease, according to data also reported at ASH 2021.4 “Understanding these associations will provide more insight into the development of hematopoietic and nonhematopoietic diseases,” he said.
Dr. McCarthy predicted that screening for MGUS could join the ranks of programs that screen asymptomatic individuals for hypertension and hypercholesterolemia (and initiate counseling on aspirin intake).5 “We may see a faster application of monoclonal protein screening for selected patient populations,” he predicted.
“What may we see in the future? As noted by the Boston and Icelandic teams, future analyses will include the cost-effectiveness of screening at-risk populations and older-age populations in general. The more sensitive method for detecting MGUS and monoclonal gammopathies of indeterminate potential using matrix-assisted laser desorption/ionization–time of flight mass spectrometry should become part of standard screening for monoclonal proteins. Clinicians may be able to screen high-risk patient populations to definitively identify patients at risk for disease development and appropriately treat them to prevent end organ damage,” he said.
Dr. McCarthy emphasized the need to refine predictive models so they more accurately identify patients needing treatment and avoid unnecessary interventions in patients not destined to experience disease progression. “These and similar large patient analyses will allow clinicians and patients to have a better understanding of monoclonal protein disorders,” he commented.
DISCLOSURE: Dr. McCarthy has served as a consultant to or received honoraria from Bristol Myers Squibb, Celgene, Fate Therapeutics, Janssen, Juno, Karyopharm, Magenta Therapeutics, Oncopeptides, Takeda, and Bluebird Biotech.
REFERENCES
1. El-Khoury H, Alberge JB, Barr H, et al: High prevalence of monoclonal gammopathy in a population at risk: The first results of the Promise Study. 2021 ASH Annual Meeting & Exposition. Abstract 152. Presented December 11, 2021.
2. Kristinsson SY, Rögnvaldsson S, Thorsteinsdottir S, et al: Screening for monoclonal gammopathy of undetermined significance: A population-based randomized clinical trial. First results from the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study. 2021 ASH Annual Meeting & Exposition. Abstract 156. Presented December 11, 2021.
3. Bida JP, Kyle RA, Therneau TM, et al: Disease associations with monoclonal gammopathy of undetermined significance: A population-based study of 17,398 patients. Mayo Clin Proc 84:685-693, 2009.
4. Bouzid H, Belk J, Max J, et al: Clonal hematopoiesis is associated with reduced risk of Alzheimer’s disease. 2021 ASH Annual Meeting & Exposition. Abstract 5. Presented December 12, 2021.
5. Dehmer SP, Maciosek MV, LaFrance AB, et al: Health benefits and cost-effectiveness of asymptomatic screening for hypertension and high cholesterol and aspirin counseling for primary prevention. Ann Fam Med 15:23-36, 2017.
