I spoke by phone Monday evening with Dr. Ravi Vij, Associate Professor, Department of Medicine, Oncology Division, Bone Marrow Transplantation & Leukemia Section at the Washington University School of Medicine.
The topic: Our quest to better understand high risk multiple myeloma.
As you might guess, Dr. Vij has a mild east Asian accent—and we were both using cell phones. Add a highly technical subject and I won’t say it was easy. But I adjusted, although I did need to stop him a number of times to repeat and clarify. Who ever said a reporter’s job is easy!
We talked for over 20 minutes. Dr. Vij patiently laid out some of the basics. Standard testing for high risk multiple myeloma starts with a simple genetic test for 13th chromosome deletion. Dr. Vij went on to describe how a relatively new test, known as FISH (fluorescence in situ hybridization) can now go even farther, identifying high risk genetic abnormalities such as chromosome 14, something he called 4/14, 14/16 and a chromosome 17P deletion.
Apparently FISH testing works great for analyzing chromosomal abnormalities in multiple myeloma patients. Why? Dr. Vij explained that myeloma cells divide very slowly, FISH does not have to be performed on cells that are actively dividing, like the more basic chromosome 13 test.
According to Dr. Vij, Velcade, and to a lesser extent Revlimid, work well in patients with deletions 13 and 4/14. Unfortunately, neither novel therapy agent works very well agains 14/16 and 17. Dr. Vij added that if you combine any or all of these with a gene p53 mutation—a frequently mutated gene in a number of human cancers—that patient’s multiple myeloma becomes very difficult to treat.
Dr. Vij discussed how traditionally, patients with one or more of these genetic difficulties may not have been viewed as candidates for stem cell transplant. Why? Because the more of these issues a patient has, the less likely any therapy is likely to work for very long.
For example, the standard time to progression for a relapsed patient who undergoes a stem cell transplant is about 18 months. On the average, that time is cut in half for a patient with one or more of these genetic abnormalities. So Dr. Vij asked rhetorically, “Is it worth it for a patient to go through all of the risks and discomfort of a stem cell transplant for eight or nine months (or less) of progress—especially when you consider three or four of those months are spent recovering?”
According to Dr. Vij, “The same is true for the new myeloma drugs. For the most part, patients with chromosomal issues don’t remain in remission as long.”
Dr. Vij confirmed the average life expectancy of a younger multiple myeloma patient without chromosomal abnormality predictors has shot up to around seven years. High risk patients are looking at median life expectancies of between three and four years—possibly even less for those with a p53 mutation.
Tomorrow I am going to pause our “high risk myeloma” series to share a conversation-ending-topic the Doctor and I discussed last evening: When a multiple myeloma patient should get a transplant.
Until tomorrow—feel good and keep smiling! Pat