Smoldering Multiple Myeloma and MGUS: Clinical Trials
The theme so far on this last day of #ASH is to treat or not to treat these conditions. Most have heard of the iStopMM study ongoing in Iceland. They invited adults in Iceland who were born before 1975 or earlier to participate in this study to detect the incidence of multiple myeloma in a large population. 148,704 people were offered participation, and in the first month, 50,000 Icelanders signed up. 80,759 in total signed up during the enrollment period, and 75,422 had their blood samples collected. I’m still boggled by the generosity of over half of the target population of Icelandic people willingly signed up to selflessly give of themselves to help the rest of the world. You can read all about the study at https://istopmm.com/
Conclusion: “In this study evaluating the presence of clonal plasma cells in bone marrow samples from IgA and IgG individuals by next-generation flow cytometry, we detected clonal plasma cells more frequently in samples from individuals with IgA MGUS compared to IgG. Additionally, the absence of clonal plasma cells correlated with a higher frequency of transient M protein and an absence of disease progression. These findings provide biological insight into the differences between IgA and IgG MGUS, which may contribute to the lower rate of progression in IgG MGU.”
The other very interesting program was two physicians stating their case for either early intervention in smoldering multiple myeloma (SMM) or active surveillance. Dr. Mateos spoke eloquently about why she believes treatment of high-risk smoldering multiple myeloma (HR SMM) can lead to a cure. Dr. K. Ramasamy says that there are potential downsides to early treatment, along with costs and toxicities.
The DreaMM-7 trial compared bBlenrep (belatamab mafodtin), Velcade (bortezomib), and dexamethasone [BVd] versus Darzalex (daratumumab), Velcade (bortezomib) ,and dexamethasone [DVd] in relapsed refractory multiple myeloma (RRMM). There was an N of 494 patients, randomized into the two arms. I was pleased to see a study with more than the usual N of single-digit patients. The surprising news was that the BVd arm performed better than the DVd arm. The primary reason for individuals who left the study from both groups was disease progression.
The next oral abstract in the session was a multi-site (124 sites in 23 countries) study of Darzalex (daratumumab) monotherapy vs active monitoring in patients with HR SMM, the AQUILA study. The dara arm showed significant improvement in time to disease progression.