VIDEO: Improved diagnosing, screening for multiple myeloma

Editor’s note: This is an automatically generated transcript, which has been slightly edited for clarity. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.

The first step is for the patient to see an oncologist, whether it would be in the community or a referral center. But yes, someone needs to think about testing patients for myeloma and then referring to oncology. And awareness of our colleagues, other specialists, and also primary care providers is very, very important. Because, really, many of those patients will see a primary doctor for back pain, would see a nephrologist for kidney insufficiency, would see a neurologist for neuropathy, and sometimes even cardiologists would pick up on some signs of myeloma. And it's very important to be aware of this diagnosis and screen. And I think it's even trickier, asymptomatic myeloma, eventually, will be diagnosed. Patients will eventually manifest the typical symptoms, but it's even more important for patients with plasma cell dyscrasias and that includes amyloidosis, of course, but even more than that. And we actually are seeing higher incidents of AL amyloidosis recently. And I don't think it's because the incidence is truly higher. I think it's actually a very positive sense that we are doing a better job in diagnosing sometimes very subtle symptoms that would lead to diagnosis of the systemic and potentially fatal condition.

We know now that [monoclonal gammopathy of undetermined significance (MGUS)] is not necessarily a completely harmless, benign chronic condition. We know that there is monoclonal gammopathy of clinical significance and that includes, first of all, MGRS, or monoclonal gammopathy of renal significance. And this one, of course, will likely be picked up on by a nephrologist. And there are multiple mechanisms of how monoclonal protein can affect kidney function. And that may be happening with really minimal paraprotein detectable in blood and minimal bone marrow plasma cells involvement. But the disease can be quite severe. AL amyloidosis is, of course, part of it, but there is light chain deposition disease, there is also proliferative glomerulonephritis that is related to monoclonal protein. And in many of those cases, a kidney biopsy is really instrumental. So increasing awareness in the nephrology field is important. Now, there is monoclonal gammopathy of neurological significance and it's not necessarily IgM neuropathy — it can be IgG and IgA. And, again, neurologists would send myeloma labs and would refer and a patient can be diagnosed and treated.

And regarding this early screening and early diagnosis, I'm very excited. We will learn a lot of very valuable insights from the iStopMM study. And I want to mention it because it's a very unique study. It's a population study in Iceland where they're offering universal screening for plasma cell disorders for all population older than age of 40. And, amazingly, they were able to enroll 50% of the eligible population. So, they have over 70,000 patients screened and enrolled. And they have so many patients with MGUS that was picked on screening and smoldering myeloma and even multiple myelomas that was picked on the study. But we will have long-term follow-up for patients who were diagnosed with MGUS on screening. And there was already a presentation of significantly increased risk of thrombotic events in patients with MGUS that was picked completely asymptomatically just because the patients were enrolled in the study. And I think more data will be coming and it's likely going to be practice changing in terms of how we are seeing patients with precursor conditions, such as MGUS and smoldering myeloma. And so, how motivated we will be to screen and pick up those patients.