VIDEO: Risk factors 'evolving' for multiple myeloma

Risk factor is an interesting concept — 25 years ago, the risk factors were during solve staging system 30 years ago. Over time, as the treatments have evolved the risk factors have also changed. And the reason is that we try to do our research and utilize our treatments to overcome the risk features. Fast forward today in the current era, the risk factors are mainly driven by, what I would say, genetic factors. What does myeloma represent and that will determine the risk feature. One of the definitions for risk factor was that if patients survive less than a certain period, 3 years for example, then those are considered high-risk patients. It used to be our 2 and it became 2 to 3. Now it’s even 3 to 4 years because patients all of them live longer. But patients who have overall survival of less than that, a quarter of the patients to 20% fit that group. And the current definition — it’s evolving. The International Myeloma Society had a meeting to redefine the risk. And what we are moving towards is mainly tumor genomics based risk. Mainly risk stratification, not just done by fish analysis but we need to use a sequencing based method for that. And what is important and currently available is that 17P deletion still remains a high-risk disease. But if we have mutations in P53 or we have clonality of 17P more than 50%, that’s a high-risk disease. Currently we also have t(4;14), t(14;16) and t(14;20) as a high -disease. But we are beginning to think that by themselves they may or may not be as critical in addition of some other genomic features to that may be required to call it a high risk, such as presence of one Q amplification or one P deletion. And so we are developing a comprehensive definition that is more centered towards tumor biology and tumor genomics and not as much on other factors.