An integrated approach to characterize high-risk disease in myeloma at Princess Margaret

Project aims/goals​​​

​​​We aim to develop and assess a framework for improved identification and management of high-risk multiple myeloma patients.

​We will pilot an integrated assessment of high risk features using a uniformly-treated transplant-eligible patient cohort based on clinical, genetic and laboratory parameters.

Summary

​​Patients with multiple myeloma who relapse within 12 to 24 months after their first treatment tend to have worse outcomes. These patients are considered high-risk. If we can identify high-risk patients earlier—before they relapse—we hope to give them more tailored treatments and monitor them more closely, but current methods for identifying these patients don’t differentiate between high and low risk as well as we believe they can. Some genetic, lab, and clinical features are known to influence risk, but they are not often used together to define who is high-risk and by combining traditional staging systems with genetic information we may be able to improve accuracy. In this study, we plan to develop a better way to identify and manage high-risk multiple myeloma. We'll look at a group of transplant-eligible patients who are all treated the same way. Using advanced techniques like next-generation and single-cell sequencing, we’ll study myeloma cells to find genetic, immune, and other markers linked to high-risk disease. We'll also look at other factors like the number of plasma cells in the blood, imaging results (PET scans), certain gene mutations, and patient frailty. At the start, each patient will get a full risk report, including possible eligibility for precision medicine trials. After transplant, we’ll use PET/CT scans and lab tests to measure how well the myeloma has responded. This study aims to show how we can bring together different kinds of information to better define and treat high-risk multiple myeloma—and improve care for patients. 

Anticipated outcomes and impact

​​We anticipate that this project will allow for better identification, stratification and treatment of high-risk multiple myeloma. By building a framework that can identify high-risk patients earlier we hope that we will be able to improve the care for this patient population, allowing for improved patient outcomes. This study will provide key insight into the process and feasibility of incorporating molecular, laboratory, and clinical features into an integrated definition of high-risk myeloma​.