Researchers have developed a calculator that may be capable of identifying patients who have multiple myeloma and light-chain amyloidosis with more benign profiles and, consequently, better prognoses, according to a novel study published by Burgos et al in the Journal of Clinical Oncology. The researchers suggested that their novel calculator could become a new standard diagnostic tool in this patient population.
Background
Multiple myeloma, the second most common hematologic malignancy, is a heterogeneous blood type. Therefore, patients may have very different clinical behaviors and responses to treatment. Further, light-chain amyloidosis is a rare hematologic malignancy with low rates of survival. Flow cytometry discriminates residual normal plasma cells and tumor cells with high accuracy.
"Using flow cytometry, we have identified a subgroup of patients—both symptomatic and asymptomatic—with a profile similar to that seen in subjects with benign myeloma precursor disease, called monoclonal gammopathy of [undetermined] significance. Likewise, we have also found this subgroup of patients in another related hematologic disease, light-chain amyloidosis," explained senior study author Bruno Paiva, PharmD, PhD, a research fellow in the Department of Haematology and Immunology at the Clínica Universidad de Navarra and Co-Director of the Hemato-Oncology Program at the Center for Applied Medical Research (CIMA).
Study Methods and Results
The researchers noted that their new open access online tool is designed to allow hematologists across the world to classify patients using routine flow cytometry data.
"Thanks to the big data generated over more than 10 years by [the Spanish Myeloma Group] (GEM-PETHEMA)—particularly at the Cancer Center Clínica Universidad de Navarra, the Hospital Universitario de Salamanca, and the Hospital 12 de Octubre in Madrid—we have developed this calculator, which identifies patients with a benign profile in real time and predicts their survival according to different clinical-biological characteristics," highlighted Dr. Paiva.
The researchers discovered that the calculator may be beneficial for asymptomatic patients and those with active multiple myeloma.
"In the case of asymptomatic [patients], even if they have other risk factors, this subgroup has a very low probability of progression. In fact, after comparing with other patients previously treated [for] developing symptoms, we have seen no changes in the evolution of the disease,” Dr. Paiva emphasized.
Additionally, patients in the subgroup with active multiple myeloma and a benign profile demonstrated an 80% rate of progression-free survival 5 years after intensive autologous transplants.
"[S]urprisingly, stopping treatment does not increase the risk of progression, even in those patients who had not achieved complete remission," Dr. Paiva revealed.
The researchers stressed that their novel calculator could help identify patients for whom a partial response to treatment should not be considered suboptimal, and should not be overtreated as a result. The investigators also confirmed the efficacy of this tool in a group of patients who had light-chain amyloidosis.
Conclusions
"Our calculator results from more than a decade of cooperative work in Spain and collaboration with other international centers. We are now making it available to the scientific community to improve the management of patients with multiple myeloma and light-chain amyloidosis in the routine clinical practice," Dr. Paiva concluded.
Disclosure: The research in this study is part of the Navarra Health Research Institute, the Cancer Center, and the Spanish Myeloma Group—and was funded by Iberdrola, through the Spanish Association Against Cancer. For full disclosures of the study authors, visit ascopubs.org.
