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Myeloma Tests With Mass Spectrometry and Beyond

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Published on April 7, 2020

Key Takeaways

  • A mass spectrometry test is more sensitive at detecting myeloma progression or presence than an SPEP test.
  • Mass spectrometry tests are being rolled out to all major cancer centers in the U.S.
  • The hope is that mass spectrometry tests will eventually replace bone marrow biopsies and help pave the way to DNA testing.

Tests designed to detect minimal residual disease (MRD) levels in multiple myeloma patients keep evolving. What does this mean for patients? Learn from footage from a recent conference as a panel of experts explain what tests are available, how they differ and what’s coming down the pipeline. 

Dr. Nina Shah, from University of California San Francisco (UCSF) Health, explains the difference between a mass spectrometry test and a serum protein electrophoresis (SPEP) test. She also shares her hope for DNA testing to replace bone marrow biopsies. 

Dr. Larry Anderson, from University of Texas Southwestern Medical Center, and Dr. Faith Davies, from NYU Langone Health, also talk about reasoning behind different tests and timing of new ones. Watch now to learn from myeloma experts.

This program is sponsored by GSK and Karyopharm. These organizations have no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.

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Transcript | Myeloma Tests With Mass Spectrometry and Beyond

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jenny Ahlstrom:                          

Hello, my name is Jenny Ahlstrom, and I’m the founder of Myeloma Crowd, and welcome to Patient Power. Today we have with us three myeloma experts at the ASH Hematology 2019 meeting. And we’re really thrilled to have them with us and talk about all the amazing advances that are happening. So, thank you, doctors, for coming.

 

We have with us Faith Davies from NYU, we have Larry Anderson from UT Southwestern, and we have Nina Shah from University of California in San Francisco, UCSF, and there’s so much to talk about.

 

As we’re talking about diagnostics, the testing seems to be getting better to detect—I mean, MRD is trying to test this lower level of disease. But other new tests like the mass spectrometry testcan you talk a little bit about that? Or liquid biopsies?

Dr. Shah:                      

That was actually presented today. I don’t know if you guys saw that, but they looked at mass spec in the context of the GEM-CESAR trial, which was a high-risk, smoldering myeloma trial. So, it was kind of like an extra thing going on with the trial, where they compared the mass spec of the blood—now this is the blood versus the serum immunofixation SPEP or common M protein we look for, versus the flow-based MRD testing. So not the genetic, but the flow based from the bone marrow.

And they were able to show, certainly in comparison with the SPEP, that this mass spec technology was more sensitive at detecting progression or detecting the presence of disease. And it was at least as sensitive, if not better than the flow. So, what does that mean for a patient? 

Because if this turns out to be true, we’re not going to have to do all these serial bone marrow biopsies that they hate, and we hate. We don’t want to subject patients to this, and it would be better if we could just use this technology.

And I’m really hoping, I really, really hope, in the next 10 years, we’re going to get this circulated tumor cells, cell free DNA, all of these things that have been being worked on so that we can eliminate bone marrow biopsies, because I just hate doing them. I don’t do them even, but I hate having to put my patients through them.

Dr. Anderson:               

Yeah, I think part of the reason they’re finding that the blood testing may be better is because if you just do a random bone marrow biopsy in the iliac crest, you may be missing what’s going on throughout the rest of the skeleton. It’s just that the myeloma can be patchy in many cases, especially in relapsed disease. And so, if you’re doing something blood-based, you’re going to catch the product from all over the body. Whether that’s with the mass spec or mass fix of the blood, or hopefully in the future cell-free DNA that’s coming loose from the myeloma cells throughout the patient’s body.

Jenny Ahlstrom:                          

And how long do you think it will take to roll mass spec out to lots of different facilities? And does it work for non-secretory myeloma?

Dr. Shah:                       

That’s a great question. 

Dr. Davies:                    

Yeah, so as far as rolling it out. All tests have to go through a kind of quality control process and to be approved by the FDA. In some cases, there’s actually a relatively easier one to roll out, because many hospitals already have a mass spec machine. 

Jenny Ahlstrom:                          

Oh okay.

Dr. Davies:                    

So they just have to buy the kits to do it, and we’ll be able to run it like that. The kits still have a process to go through. I think it will still be a couple of years. 

Jenny Ahlstrom:                          

And how many facilities are doing it right now?

Dr. Davies:                    

So, in the U.S., many of the big myeloma academic centers are doing it. They have slightly different tests. There’s also a company that’s producing a kit as well.  

Dr. Anderson:               

And to answer your other question, it probably wouldn’t really help if there non-secretory, because there’s really no marker in the blood. 

Jenny Ahlstrom:                          

Right, so you’re still not picking up the M protein?

Dr. Anderson:               

Unless what we though was non-secretory, maybe they’re just minimally secretory, and there may be a small percentage of patients where it can pick that up. If they’re completely non-secretory, it wouldn’t work.  

Dr. Shah:                       

That’s why I’m really excited about the DNA, because that’s the fruit, right? The cell. You know, all these proteins are just the petals on the flower, right? You want to find the flower. So, I think this DNA approach will be really cool, and I’m not smart enough to develop it but hopefully someone else is. And I really hope that we can do that soon. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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