What Factors Determine If I Have High-Risk Myeloma?

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Jack Aiello:

Dr. Fonseca, on the slide it talks about what's my myeloma risk level.  Can you say something about what the heck that means in terms of high?risk patients or not high-risk?  

Dr. Fonseca:

Happy to do that.  As many of you know as we engage with you and we talk in the clinic and certainly as we do in our papers, we often put labels to the type of myeloma we're dealing with, so to speak, the flavor of myeloma we're dealing with.  So we've come up with this classification of risk, risk stratification, and the idea is that we think it's important that in the clinic you identify those patients that have some features that would make it more likely for the myeloma to be stubborn or come back, and what we do in the clinic is because of that information we change how we approach things, so we have different management and plans for patients who have high?risk myeloma.   

Now, there are many ways in which you can measure this.  There are many reasons why one may be at the high risk for having complications or problems, but usually what we're doing here is we're referring to the myeloma cells themselves, and what we really are saying is we're referring to their genetic makeup.   

I think many of you know we always talk about the genetics in myeloma, which, by the way, these are genetic changes that only occur on those myeloma cells.  These are not changes that exist anywhere else in your body.  As a consequence nothing to be worry about, say, passing it from one generation to the next.  These are very specific genetic changes that happen in those myeloma cells, little typos or hiccups, if you may, that those cells have.   

We have multiple ways of testing this.  I don't think probably it's going to be very good to go through all the technicalities, but certainly there's a few factors.  We've done this mostly through a test called FISH, that there's two translocations, t(4;14) 14;16, and loss of what we call p53 or 17p deletion that kind of raise little bit of more extra awareness on our part to say we may need to approach this different.  

That's why we talk about high risk.  At the end of the day it just means that it's a myeloma that can adapt a little bit more, and because they can do that they can sometimes overcome some of the effects of chemo.  So we're more insistent and more intense in how we provide treatments for patients with high-risk disease.   

Jack Aiello:

These translocations and deletions you're talking about are chromosomes where parts of different chromosomes might switch places or parts might be missing and such, if I understand correctly.  

Dr. Fonseca:

That is correct.  If you pay attention you'll see a lot of them involve chromosome 14, so as you know, we have genes—all of our cells in our body have genes and these genes are the DNA, but they're packed in little units, and when those units are compact they're chromosomes, like little spools of thread, right?  

Chromosome 14 contains the genes that make the immunoglobulins, the main part of the immunoglobulins, what they call the heavy chain.  So to work normal plasma cells, as Dr. Kaufman was saying, is a process where they're always editing, cut and paste, cut and paste, cut and paste. Every now and then if one of those cuts is not pasted in the right way, it's pasted maybe in the wrong chromosome, that's what we call a translocation.  

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.