The Future of Multiple Myeloma Management
MAY 05, 2020
Ola Landgren, MD, PhD: We are already starting to see newer versions of these protein assays, and they are based on other types of platforms. There is work ongoing using high throughput mass spectrometry. You can send laser beams through very small volumes of serum. You can take 10 mcL of serum, which is virtually nothing, and you can do that for, say, 10 seconds or so. You can do that in replicates. When we do this in the research setting right now, we could have 5 replicates. It is possible in the future that you can do less of it, but 10 seconds times 5 is less than a minute; that’s 50 seconds. And if you do that you would see the same protease, we have been talking about today using current technology, but you have 100 to 1000 times higher sensitivity. So I think the mass spectrometry–based technology platform for tracking of proteins will definitely replace what we currently have. I think the protein electrophoresis and immunofixation will go away. Probably also free light chain assays will eventually go away when there are new ways to do it on the mass spectrometry. Right now we have research capability to replace the immunofixation with mass spectrometry from a research point of view, but we still need free light chains. For the next versions of mass spectrometry platform assays, everything probably will be integrated. There are a lot of kinks when it comes to quantification. In particular, there are some missing pieces to track the free light chains. I think in a year or 2 we will sort all these out from a research point of view.
Simon Murray, MD: It sounds to me like you’re in the right place. Multiple myeloma seems like a field where there are a lot of promising new developments, and the chance to help people and save their lives and improve their lives, with a lot of new technologies that are coming and drugs that will be developed.
Ola Landgren, MD, PhD: Myeloma is, in a way, a poster child of all the success we have been experiencing in cancer medicine over the past 10 or so years. I mentioned before that overall survival used to be 1 to 3 years.
Simon Murray, MD: Yeah, that’s what I was trained for.
Ola Landgren, MD, PhD: Now we have more than 10, 20 years for the overall survival for patients. With the newest therapies, regarding our research program, we can achieve complete response rates in up to 80% and 90%—or actually 90% of our patients—and we can probably achieve minimal residual disease negativity in maybe 70%, 80% of the patients. So no detectable disease. Having access to new drugs partnered with modern tracking and follow-up strategies—that’s how we will improve outcome. Hopefully can find curative treatments for our patients.
Simon Murray, MD: Yes, that is really amazing. I spoke to an oncologist today who is 70 years old, and he said to me, “I am really jealous of my younger colleagues, because they’re going to live long enough to see amazing outcomes in the next 20 years.” And I was quite impressed by that statement, because I recently retired as an internist, and the biggest comment I heard was, “How did you get out? Don’t you feel great about being out?” Like I escaped from jail, you know. But this oncologist was so promising—he wished that he could be younger so he could see the future. It was just such a contrast, you know. Interesting.
Ola Landgren, MD, PhD: It is fascinating. There are a lot of new things going on. Sometimes I feel it’s very hard to keep up with all the developments. But everything that changes, changes for a good reason, and you see how well the patients are doing. They’re living much longer, and the quality of life is getting better and better all the time. It’s just amazing.
Transcript Edited for Clarity