In this week’s Myeloma Minute, a new video gives an overview of the IMF Black Swan Research Initiative (BSRI). As we move into 2019, there are ambitious plans to accelerate the search for a cure, uncover the mysteries surrounding early disease onset, and focus on potential prevention strategies.

Early disease is earlier than we thought

Using the extremely sensitive mass-spectrometry method to detect very low levels of myeloma protein in the blood has shown us that low levels of MGUS (monoclonal gammopathy of undetermined significance) can be present from a very young age. This has led to studies of individuals between 18 and 40. Such studies will provide the opportunity to understand the initial “clonal competition” process, which results in the persistence of dominant clones producing MGUS, then SMM (smoldering multiple myeloma), and MM (multiple myeloma).

What are the trigger factors? What is the immune defect or “Achilles’ heel” that allows the abnormal clones to expand? What toxic exposure may have damaged the myeloma cells and/or compromised the immune microenvironment in the bone marrow? All these questions are very much answerable—some during 2019!

How myeloma becomes “multiple”

The development of multiple myeloma deposits, lesions, and collections of myeloma cells in the bone marrow of bones throughout the spine, ribs, pelvis, and other areas typically affected by myeloma has also remained a mystery. Now, as part of the BSRI projects, research teams in both Salamanca and Pamplona, Spain have demonstrated that myeloma cells in the bloodstream travel to these bone marrow sites and establish new sites of disease in areas with a favorable microenvironment. This seeding process is linked to increasing numbers of plasma cells measurable in the blood. It seems that this may be one of the earliest indicators of disease progression (from MGUS or SMM to MM) or relapse in a patient who may have achieved MRD negative/undetected status in the bone marrow even at 10-6 level!

This approach is like taking myeloma research back to the “big bang” moment, which astrophysicists deem the instant our universe of galaxies, stars, and planets first came into existence. In the case of myeloma, it is a process we want to prevent or treat as early as possible at a point of “biochemical relapse/progression” to achieve the best results. Again, we will be making progress on this in 2019, linking studies of what treatments might eradicate early disease with new randomized trials.

Bottom line

There is an exciting year in store for us as the IMF moves ever closer to fulfilling our mission of “improving the quality of life for myeloma patients while working toward prevention and a cure!”

Dr. Durie sincerely appreciates and reads all comments left here. However, he cannot answer specific medical questions and encourages readers to contact the trained IMF InfoLine staff instead. Specific medical questions posted here will be forwarded to the IMF InfoLine. Questions sent to the InfoLine are answered with input from Dr. Durie and/or other scientific advisors and IMWG members as appropriate, but will not be posted here. To contact the IMF InfoLine, call 800-452-CURE, toll-free in the US and Canada, or send an email to [email protected]. InfoLine hours are 9 am to 4 pm PT. Thank you.



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