Transcript:

This week’s “Ask Dr. Durie” comes from a patient who wants to know “Can blood testing replace bone marrow testing?” And this is a very important question, a very practical question because obviously, it’s very uncomfortable, and difficult, and even expensive to get a bone marrow test done.
 
So, unfortunately it is essential to do a bone marrow test at the time of initial diagnosis because that is how we make the diagnosis. Myeloma is a disease of the bone marrow and we have to assess what percentage of myeloma cells are present in the bone marrow. So, this is an essential test at diagnosis. It’s also an essential test at key follow up points, particularly at best-response to see, as the myeloma actually been cleared out of the bone marrow using the therapy. And so, this would be a key test for assessing minimal residual disease, what we call “MRD”, to see if the bone marrow is MRD negative.
 
However, aside from that type of essential bone marrow testing, it’s quite encouraging to know that we do have new precise tools that will greatly enhance our ability to accurately measure and assess the status of the patient using blood tests.
 
And the three tests I would draw your attention to are, number one, mass spectrometry, and this is a new serum test which is available through the Mayo Clinic in Rochester Minnesota, so sample can be sent by your doctor to the Mayo medical labs to have this test done. And this test measures the amount of the myeloma protein, what we called the “M component,” in the blood at very very very low levels. And so, this can be a way to assess the disease without needing to resort to a bone marrow test.
 
Another test which is available is to look for the presence of myeloma cells in the blood, monoclonal plasma cells. And this is something that we have become increasingly aware of, that there actually are frequently myeloma cells in the blood.  And that they can be measured and assessed in a variety of ways. And so, now samples can actually be sent off to see, are there myeloma cells in the blood? And as you might expect, if that is the case this does indicate the possibility of some active disease. And so, important to know.
 
And then the final testing is to look for mutations. What are the damaging mutations that are affecting the myeloma? And it turns out that you can assess this by studying DNA in the blood. And one of the collaborators in the Black Swan Research Initiative, Dr.  Andrew Spencer has recently published several papers showing that at the time of relapse, mutations, particularly affecting genes called KRAS and NRAS can be noted in the blood and can be an indicator not just of relapse, but the specific mutations that require attention.
 
And so, the BOTTOM LINE is that bone marrow testing is essential at the beginning and for close monitoring. However, in the near future, precise blood testing will become a reality for accurate ongoing measurement of the disease. And so, this is really an encouraging note for the future.
 

Dr. 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®.