Rounds with the Investigators 2012 | Multiple Myeloma

QUESTION: What is the best risk stratification test: cytogenetics, FISH, MyPRS™ GEP70, other GEP tests or “other”?

DR RAFAEL FONSECA: The question is a very pertinent one because I think more and more people have moved away from conventional or classic cytogenetics and I think there’s a good reason for that. Sure enough, if they’re abnormal, you know that the patient has very high-risk disease. But the yield for abnormalities, this is about 8 to 9% of cases that you get informative metaphases. So it’s, for the most part, it’s just wasting money, the other 90% of patients.

Now, we have traditionally used FISH and we still use that at our institution to prognosticate patients. We were having a discussion at lunchtime, I think we’re moving to a point that we're not quite sure exactly how to use different therapies according to this, but most of us are thinking about more prolonged strategies or more intense strategies still for the high risk, perhaps even with treatment, post-transplant, for the very high-risk patients. So we continue to use FISH for that.

Now, the last one, which is a test that is now offered through Signal Genetics and some of the subsidiaries that have contracts for that, it’s also a great a test. The net result for hazard is greater, so that’s the one that tells you about the greatest-risk patients, although it does drop down a little bit the percent of patients — it goes from 25 to about 15%. Strictly speaking or scientifically speaking, the MyPRS™ would be probably the most powerful test. But for what we’re doing in the clinic, probably one or the other is appropriate. But I think one has to do some risk stratification because not all myelomas are the same. And we were saying at lunchtime, I don’t think you can get into the bandwagon of “Gee, myeloma is a chronic disease, you’ll be around here 10 years from now” if we do have high-risk genetic markers.