An Expert Defines High-Risk Myeloma

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High-risk multiple myeloma can be a frightening term.  At a recent town meeting at MD Anderson Cancer Center, Dr. Gareth Morgan from the University of Arkansas for Medical Sciences explained that risk is defined in many different ways.  He tells us which factors are used to determine the level of risk, and what you should keep in mind if you are told your disease is “high-risk.”

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High-Risk Multiple Myeloma Clinical Trials

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Transcript

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. 

Jack Aiello:

Dr. Morgan, when a patient is diagnosed, sometimes they’re told they are high-risk patients. Can you say a little bit about what that means?

Dr. Morgan:

So that’s the complicated question to that. And it’s really, really important that patients understand that there is not, as yet, a really good definition of high risk. And high risk means one thing to one person and something else to another. So always be kind of careful about what you’re told and research it yourself.

And never take anything completely at face value. That’s really, really good advice. There are some clinical subtypes of myeloma where you have circulating plasma cells in your blood that clearly are high risk, and there’s little difficulty in identifying that. But when you start looking in smoldering myeloma, then you suddenly get called, you know, one moment you’ve got smoldering myeloma, then somebody changes the definition. And you suddenly have high-risk disease. Is that real? Do you have high risk? Do you have exactly what you had before?

And so just to put some detail on that, people define risk groups by some clinical factors, and there are some laboratory tests. And the laboratory tests, the most commonly used is called iFISH, which is a kind of crazy name for a test that looks at the chromosomal structure in the cancer cells.

And some of those people think a high risk will behave more aggressively than others. The evidence to support that, in smoldering myeloma at least, is not strong. In newly diagnosed myeloma that fills all of the criteria, then again you can use iFISH. And there are clearly some groups that behave differently to others.

We’re just at a position where new laboratory tests, such as gene expression profiling, can help you really define what your risk status is. And there are maybe seven different diseases that are present in myeloma, each of which has a distinct response to treatment. And there is high-risk and low-risk disease.

People with low-risk disease are now doing very, very well—15 percent of people who have high-risk, newly diagnosed myeloma need to enter clinic trials so as we can define good treatments to improve the outcome for those set of patients.

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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Page last updated on April 8, 2016