The iStopMM research project is about to start in Iceland. It is supported through the IMF’s Black Swan Research Initiative®, and literally will include Screening, Treating Or Preventing myeloma. Beginning in October 2016, approximately 140,000 people over age 40 in Iceland will be screened with SPEP (serum protein electrophoresis), UPEP (urine protein electrophoresis), and Freelite tests to see if they have MGUS (monoclonal gammopathy of undetermined significance), smoldering multiple myeloma (SMM), or full-blown multiple myeloma (MM). If they have MGUS or SMM, they will be initially monitored. If they have myeloma, they will be treated.

This innovative study, led by Prof. Sigurdur Kristinsson at the University of Iceland, will also include an assessment to evaluate what may have caused MGUS, SMM, or MM. Samples will be placed in a biobank for future testing. Patients with high-risk SMM will be treated with a “CURE trial” protocol, as described by Black Swan Research investigator Dr. Shaji Kumar at the 2016 International Myeloma Working Group (IMWG) Summit held in Copenhagen in an article here.

Obviously, all of this is fantastic for patients in Iceland and can lead to the elimination of myeloma in that somewhat remote country. But the broader implication of the iStopMM project is that it will improve the lives of myeloma patients around the world by enabling researchers to:

1.      Discover the causes of myeloma

First of all, we will learn a lot about what is causing myeloma. Which patients are getting myeloma? Which are not? And why? If causation is linked to agricultural chemicals or other exposures, prevention strategies can be broadly applied. An emphasis on prevention is the ultimate paradigm shift necessary to achieve a healthy population and will entail a global change in health policy. We must consider exposures during pregnancy and childhood, as well as the evolving recommendations for adults.

2.      Understand disease progression

Because so much is known about the genetics of Iceland’s population—and the study will illuminate the genetic factors linked to disease progression—it will be possible to develop precise predictors of progression from MGUS to SMM and from SMM to MM. Instead of, for example, a high-risk myeloma patient’s approximately  80% likelihood of developing myeloma in 18 months to 2 years, a precise algorithm will be developed to predict early disease progression. This tool will be applicable to all patients since the underlying mechanisms of disease progression will be tracked. Reliable prediction will lead to a high level of confidence that we can intervene with early curative combination therapy. Managing the disease before dangerous mutations emerge is a key concept of the BSRI.

3.      Control treatment costs

We predict that screening and early treatment will also be the way forward to control the costs of therapy. An early, defined course of therapy, even if expensive, is much more manageable than an open-ended need for ongoing treatment. In Iceland, this approach will be evaluated for the first time. Its success will cause a paradigm shift in how patients everywhere are treated.  We expect that we will have good data quickly: within 1 to 3 years, the information will be gathered about baseline findings, progression, and treatment results.

4.      Expand the iStopMM approach beyond Iceland

What is potentially even more exciting is that there can be similar iStopMM programs in the US and other countries as well. Indiana starts with an “I,” so IMF Medical Liaison Dr. Rafat Abonour of Indiana University has proposed a similar program in the state of Indiana! This trial would be for a segment of the population at greatest risk for myeloma. It has also been proposed that an iStopMM-type program be conducted in a small island population where myeloma is very rare, in fact much less common than in Iceland. The island proposed is Malta, where apparently only 1 or 2 new cases of myeloma occur each year. Is it the Mediterranean diet, wonderful climate, lack of pollution, family genetics, or something else? Comparing Malta with Iceland can be very informative and perhaps will underpin new prevention strategies.

Iceland is a wonderful trial location, where those participating in iStopMM are the first to benefit from a creative new approach. Not far behind, however, can be the rest of the world: learning, screening, and treating to achieve the best outcomes! Stay tuned.

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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