Is the treatment of high-risk SMM the way for achieving the cure?
Sep 23, 2021
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Dr. María-Victoria Mateos discusses the progression from MGUS to MM, risk stratification for SMM, and clinical trials showing benefits of treating high-risk SMM. Early treatment of SMM is key in her cure roadmap, with two curative approaches in clinical trials.
Early treatment of high-risk SMM can delay progression to MM.
Identifying high-risk patients through refined clinical models is crucial for optimal management.
Deep dives
Cure Definition and Comparative Survival Rates
The podcast episode delves into the evolving definition of cure in multiple myeloma, emphasizing the need to achieve disease-free survivors with an annual death rate similar to that of the general population. While some hematological diseases like lymphomas are considered curable, there exists a significant survival gap in myeloma compared to the expected rates. The complexity of myeloma, varied disease presentations in patients, and the importance of early detection and intervention are highlighted as crucial factors in addressing this gap.
Managing Plasma Cell Disorders and Risks of Progression
The discussion shifts towards managing plasma cell disorders by considering individual molecular abnormalities and the bone marrow microenvironment to determine the necessity of early intervention. The podcast references a study on genomic sequencing in pre-malignant myeloma conditions, showcasing distinct genetic landscapes between stable and progressive cases. Not all patients with early detected disorders progress to myeloma, necessitating a personalized approach based on risk factors and cytogenetic abnormalities for optimal management.
Clinical Trial Efficacy and Potential Strategies for Cure
An overview of phase three clinical trials emphasizes the benefits of early treatment in high-risk smoldering myeloma patients, leading to improved time to progression and overall survival. The importance of identifying high-risk patients using refined clinical models, such as the International Myeloma Working Group 2020 criteria, is discussed. The podcast concludes by highlighting the significance of achieving minimal residual disease negativity for predicting survival outcomes and the ongoing investigations into curative approaches based on sustained MRD negativity and therapeutic combinations.
During the 7th World Congress on Controversies in Multiple Myeloma (COMy), the Multiple Myeloma Hub hosted its first Satellite Symposium: Should 'cure' be the goal for multiple myeloma? María-Victoria Mateos, University Hospital of Salamanca, Salamanca, ES, answered: Is the treatment of high-risk smoldering multiple myeloma (SMM) the way for achieving the cure?
In this podcast, Mateos discusses the progression of monoclonal gammopathy of undetermined significance (MGUS) and SMM to MM from a molecular point of view. She explains the 2/20/20 risk stratification model for SMM, and the phase III clinical trials that have demonstrated a benefit in treating patients with high-risk SMM to delay the progression to overt MM. In her road map to cure MM, early treatment of SMM is a crucial step, and she presents two curative approaches being currently investigated in clinical trials.