Screening At-Risk Populations Can Decrease Myeloma Deaths

Simply knowing who to screen, and when, could reduce myeloma-related mortality rates, according to recent research published in the JCO Clinical Cancer Informatics.

The root cause of many cases of myeloma is monoclonal gammopathy of undetermined significance (MGUS), a blood disorder where white blood cells produce too much M protein. While MGUS does not present with many obvious signs of disease, the condition is easily detected through a blood test. So, identifying who should be screened for it can lead to earlier intervention for patients with myeloma, or possible prevention of the disease overall.

CURE spoke with two authors on the study, Philipp M. Altrock, Ph.D., assistant member at Moffitt Cancer Center’s Department of Intergraded Mathematical Oncology, and Michael M. Tomasson, M.D., of the Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, about their findings.

Why was it important for you and your team to conduct this research and find who is at high risk?

All multiple myeloma cases start with a stage called MGUS. Right now, there are no screening or other strategies to prevent multiple myeloma, and we wanted to know how we might one day help eradicate multiple myeloma by preventing it from developing in the first place.

The epidemiology of multiple myeloma tells us that disease risk varies with certain factors, such as gender, African ancestry and certain genes. Screening for MGUS is currently not performed regularly — this precursor stage is most often discovered by accident. We developed a computer model of disease onset and progression, and then simulated disease progression in two ways: with and without screening for MGUS.

It was important to us to model the question of what could happen to the overall population with disease if we screened for MGUS and then intervened with a hypothetical drug that can reduce progression, potentially very effectively.

How can you determine who should be screened for MGUS, and when?

We used mathematical and computational modeling, paired with statistics, to test a large number of possible screening options. We could conclude that in individuals with a high statistical risk of MGUS (e.g. African American males, or individuals who have relatives that were diagnosed with multiple myeloma) could benefit from screening in order to find the disease, or its precursor stages, early. A good age to consider for a first screen might be 60, or even a few years earlier.

Is screening still important after a patient is diagnosed with myeloma?

No, after the diagnosis of multiple myeloma, treatment rather than screening is most important. However, after MGUS diagnosis, follow up screens to determine the individual patient’s rate of progression will be very important.

What is the grand takeaway you want to offer to our audience — patients, survivors and caregivers?

Tremendous advances in treatments for myeloma have turned it into a chronic disease with an improved quality of life and duration of survival. As researchers continue the search for cures, we want the community to know that we have opened a new front on the war against myeloma.

What are the next steps in this line of research?

MGUS is relatively common and in most cases, people will live well with the condition unnoticed for the rest of their lives. Our future studies will focus on the earliest stages of the disease, such as smoldering multiple myeloma, identifying cases that progress faster and faster over time (so called evolving disease), and understanding underlying biologic mechanisms. Then we can develop new targeted treatments to prevent disease progression.