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!”

Image of Dr. Brian G.M. DurieDr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.

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