Are Myeloma Experts Redefining High-Risk Status for Older Patients?

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Topics include: Living With Multiple Myeloma

What factors determine if a multiple myeloma patient is high risk? How do experts define risk in elderly myeloma patients? Myeloma expert Dr. Tanya Wildes, from the Washington University School of Medicine, discusses the traditional approaches to categorizing myeloma risk and explains how researchers are reframing the way to assess and manage risk in the older myeloma patient population. Watch now to learn more.

 

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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.

Andrew Schorr:

Hello and welcome to Patient Power.  I'm Andrew Schorr, today based in Los Angeles.  Our guest is a myeloma specialist joining us from St. Louis and Washington University School of Medicine and the Siteman Cancer Center. That's Dr. Tania Wildes, who is a specialist in myeloma and particularly as it relates to older people. Dr. Wildes, welcome to Patient Power.  

Dr. Wildes:

Thank you so much for having me.  It's an honor.  

Andrew Schorr:

Dr. Wildes, very recently we had the big ASCO medical conference, American Society of Clinical Oncology, and you spoke there specifically talking about managing the high risks in people who are older with myeloma.  So tell us about what may be significant from that that we want to tell patients, particularly older patients or their family members about managing myeloma today.  

Dr. Wildes:

So what I covered during my session there was first of all talking about the factors that are traditionally looked towards when we're defining a patient's myeloma as being standard risk or higher risk, and certainly that nomenclature typically refers to things like the international staging system stage, chromosomal abnormalities, combining those two and adding in LDH to form the revised international staging system or emerging technologies like gene expression profiling.  

And so traditional approaches to categorizing a patient's myeloma as high risk is focus on a disease?focused outcome.  And certainly when studies have looked at an applicability of those frameworks in patients, certainly the presence of chromosomal abnormalities traditionally considered high risk does confer a poorer prognosis in patients with those high?risk chromosomal abnormalities.  But Dr. Charlotte Pawlyn recently presented at ASH, and it will be soon in manuscript form, data none demonstrating that across the life span the relative importance or impact of those chromosomal abnormalities actually tends to decrease.  

And of increasing importance across the age span are more patient?centered factors, putting the patient at higher risk for adverse outcomes.  The international staging system increases in importance across the age span relative to the decreasing proportion of importance of the chromosomal abnormalities, and one explanation for that is that the ISS staging takes in account the beta 2?microglobulin which can be reflective of renal function since the beta 2?microglobulin is renally cleared.  And so in that case it may be that it's not so much reflective of the myeloma biology as the patient's renal function, which when I look at that through the eyes of a geriatrician I would call that the patient's co?morbidities, meaning other medical conditions that are impacting their overall health. And then within Dr. Pawlyn’s data they also show the increasing importance of performance status.  

And so in my talk at ASCO I challenged the audience to kind of reframe their considerations of what high?risk disease is to encompass not just disease?specific factors but also characterizing the ageing?associated vulnerabilities that are present in an older patient with myeloma.  

Andrew Schorr:

Okay.  I got it.  So let me just state that back to you to make sure myself and patients and their family members understand.  So we're in this world of testing, and often we've heard about chromosome testing, genomic testing, all that, but what you're saying is whether somebody is told that they're high risk or their family member is may depend now more and more now on other factors.  And one which them you're talking about, kidney function, for example, and tests for that.  And co?morbidities could be do they have diabetes, do they have heart issues, right? 

Dr. Wildes:

Right.  

Andrew Schorr:

Are they able to walk very much, their exercise status, and that has to do with how you evaluate it and say, is this patient, my patient at higher risk or what can we do to help them deal with these other aspects so they can live longer.  Did I get it right?  

Dr. Wildes:

Absolutely. 

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 August 8, 2019