Multiple myeloma is a type of blood cancer that affects plasma cells, which are responsible for producing antibodies that help fight infections. It is the second most common blood cancer in the United States, affecting about 34,000 people each year. Multiple myeloma can cause various symptoms, such as bone pain, kidney problems, fatigue, infections, and nerve damage.
While there is no cure for multiple myeloma, there are many treatments available that can help control the disease and improve the quality of life of patients. In fact, the field of multiple myeloma has seen remarkable progress in the past decade, with new drugs, combinations, and strategies that have improved survival and outcomes for many patients.
In this article, we will highlight some of the emerging topics of importance in multiple myeloma, based on a recent interview with Dr. Rami Nahas, a hematologist-oncologist and an expert in multiple myeloma at the University of Michigan Rogel Cancer Center.
The Role of Minimal Residual Disease Testing
One of the topics that Dr. Nahas discussed was the role of minimal residual disease (MRD) testing in multiple myeloma. MRD testing is a way of measuring how many cancer cells are left in the body after treatment, using highly sensitive techniques such as flow cytometry or next-generation sequencing. MRD testing can help determine how well a patient is responding to treatment and whether they need more aggressive or less intensive therapy.
According to Dr. Nahas, MRD testing is becoming more widely used in clinical trials and practice, especially for patients who achieve a complete response (CR) or a very good partial response (VGPR) to treatment. MRD testing can help identify patients who have a deeper response and a lower risk of relapse, as well as patients who have residual disease and a higher risk of relapse. This can help guide treatment decisions and tailor therapy to each patient’s individual risk profile.
Dr. Nahas also mentioned that MRD testing can be used to monitor patients who are on maintenance therapy or who stop treatment after achieving a sustained response. MRD testing can help detect early signs of disease progression and prompt intervention before symptoms develop. However, Dr. Nahas cautioned that MRD testing is not perfect and has some limitations, such as variability between different methods and laboratories, lack of standardization and validation, and potential false negatives or positives.
Therefore, Dr. Nahas emphasized that MRD testing should be interpreted in the context of other factors, such as clinical symptoms, imaging results, biomarkers, and patient preferences. He also stressed that MRD testing should not replace the current criteria for response assessment in multiple myeloma, but rather complement them and provide additional information.
The Impact of COVID-19 on Multiple Myeloma Care
Another topic that Dr. Nahas addressed was the impact of COVID-19 on multiple myeloma care. He acknowledged that the pandemic has posed many challenges and uncertainties for patients with multiple myeloma, who are at higher risk of severe complications from COVID-19 due to their compromised immune system and comorbidities.
Dr. Nahas shared some of the strategies that he and his colleagues have adopted to provide optimal care for their patients during this difficult time. These include:
- Using telemedicine whenever possible to reduce exposure and travel
- Prioritizing oral or subcutaneous drugs over intravenous drugs to reduce clinic visits
- Avoiding immunomodulatory drugs (IMiDs) or steroids in patients who are not vaccinated or have active COVID-19 infection
- Encouraging vaccination for all eligible patients and their close contacts
- Educating patients about the signs and symptoms of COVID-19 and when to seek medical attention
- Providing emotional support and resources for patients who may experience anxiety, depression, or isolation
Dr. Nahas also highlighted some of the positive outcomes that have emerged from the pandemic, such as increased collaboration and communication among health care providers, researchers, and patient advocacy groups; increased awareness and education about multiple myeloma; and increased participation in clinical trials and registries.
Dr. Nahas expressed his optimism that the pandemic will eventually subside and that multiple myeloma care will resume to normalcy. He also expressed his hope that some of the lessons learned from the pandemic will persist and improve the quality of care for patients with multiple myeloma in the future.
The Future Directions of Multiple Myeloma Research
The last topic that Dr. Nahas touched upon was the future directions of multiple myeloma research. He noted that there are many exciting areas of investigation that are ongoing or planned in multiple myeloma, such as:
- Understanding the biology and genetics of multiple myeloma and its subtypes
- Developing novel drugs and combinations that target specific pathways or mechanisms of resistance
- Exploring the role of immunotherapy, such as CAR T cells, bispecific antibodies, and vaccines
- Evaluating the optimal sequencing and duration of therapy for different patient populations
- Comparing the efficacy and safety of different treatment strategies, such as induction, consolidation, maintenance, and salvage therapy
- Incorporating patient-reported outcomes and quality of life measures into clinical trials and practice
- Addressing the disparities and barriers to access and care for underserved and minority patients
Dr. Nahas concluded by expressing his enthusiasm and gratitude for being part of the multiple myeloma community, which he described as a “family” that is dedicated to advancing the science and improving the lives of patients with multiple myeloma. He encouraged patients to stay informed, engaged, and hopeful, and to participate in clinical trials and advocacy efforts whenever possible.
He also thanked the Targeted Oncology team for inviting him to share his insights and expertise on multiple myeloma.
Multiple myeloma is a complex and challenging disease that requires a multidisciplinary and individualized approach to treatment and care. However, thanks to the remarkable progress and innovation in the field of multiple myeloma, there are more options and opportunities than ever before for patients to achieve better outcomes and quality of life.