Published on February 21, 2020
- Recommended tests for newly diagnosed patients include blood work and imaging, FISH and a bone marrow biopsy.
- MRD testing typically occurs after treatment to measure response.
- Minimal residual disease (MRD) status indicates the number of myeloma cells that remain after treatment.
Multiple myeloma expert Dr. Krina Patel, from The University of Texas MD Anderson Cancer Center, discusses the recommended diagnostic tests to identify risk features of the disease and help tailor treatment to patients. Dr. Patel also explains what testing is typically done after treatment to measure response.
This town hall meeting is sponsored by Janssen Biotech, Inc. and Karyopharm Therapeutics with additional support to our partner, Myeloma Crowd (MCR), from Takeda Oncology and Foundation Medicine. These organizations have no editorial control, and Patient Power is solely responsible for the content. It is produced by Patient Power in partnership with The University of Texas MD Anderson Cancer Center.
Transcript | What Tests Are Recommended for Newly Diagnosed Myeloma Patients?
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Dr. Patel, what tests do you order for that newly diagnosed myeloma patient? And in particular, does it include MRD testing?
Sure. So, for us, a lot of my patients come from the outside center where they’ve had some studies done and we usually just try to make sure everybody does the blood work, so SPEP and immunoglobulin light chains. We make sure they’ve had some type of imaging, either PET scan or MRI, which we’ll talk about a little bit later.
In terms of bone marrow, you have to have bone marrow for diagnosis. I’ve had a couple of patients come to me having started treatment and never had a bone marrow. That doesn’t happen very often, but that’s really important. That’s where we get all this genetic testing information from the beginning.
We don’t do MRD testing at the beginning. When you’re newly diagnosed, we have lots of cells. The idea of what MRD is, are there any cells left after we’ve started treatment? So, we do FISH testing and we do cytogenetics and all those things that Dr. Lin talked about to help decide are there high-risk features or are there standard risk features? That helps us tailor our treatment a little bit. So, no MRD testing at the beginning. We usually do it after treatment.
Usually, we do it after—let’s say someone’s newly diagnosed and they’ve gone through transplant, usually three or six months depending on the center, we do another bone marrow to see the response. That’s when we do MRD testing.
Usually, that’s also when the M-protein has gone down to possibly zero. That’s usually when you can’t find the myeloma cells just by looking under the microscope with stains, which is called IHC. That’s where we really want to know how deep, if we can go deeper, can we really not see that myeloma?
So, in that case, the patient is—chances are, they’re in a complete response?
And then you look at MRD…
…to see if they’re MRD-negative on top of it.
For us, we do via FLOW. We are working on the next-generation sequencing as that is approved to do that as well.
And next-generation sequencing might change that, because they’ll want you to do an NGS test at diagnosis, right?
Right. So, at that point, you want to know how to find those cells. So, to have something at baseline is important.
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