The Bottom Line: Mass spectrometry, for highly sensitive myeloma protein level measurement, and next-generation flow, for assessing minimal residual disease in bone marrow, are exciting new tests expected to be approved for monitoring myeloma in 2024. These promising tests have the potential to revolutionize deep myeloma response monitoring, coinciding with the introduction of new treatments within the same timeframe.
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This week’s Ask Dr. Durie comes from a patient who wants to know if there are any new tests that he should be getting to monitor his myeloma. A very, very good and reasonable question. Over time, we have introduced a number of new tests, and the question is, are there new and important ones that this patient should be adding to the regular checklist?
So, the answer to this question is kind of yes and no. The basic testing for myeloma really has not changed that much over the years. We continue to use a routine blood count, checking chemistry panel, check free light test for late change in the blood and urine, serum beta two, microglobulin, some of the basic testings. We also do our bone marrow testing and check the chromosomes using FISH testing.
And then obviously, because myeloma can seriously affect bone, we have a number of imaging tests that we use, including CT scanning, MRI, and PET/CT scanning.
One innovation is that here recently we have been using a technique called whole-body low-dose CT scanning to screen for myeloma lesions at the time of diagnosis and also for periodic monitoring.
And so, this is one new test that we do use. Beyond that, there are really two other major new tests which are on the horizon and are likely to be approved early in 2024. These two tests are number one. Mass spectrometry, which is a very, very sensitive test for measuring the level of myeloma protein in the blood. And then the second test is called next generation flow, which is a method of assessing minimal residual disease.
And so, this is a method to see if there is any residual myeloma in the bone marrow. And this is done by passing the bone marrow through a flow cytometer and assessing if any myeloma cells can be detected. This is a new method that will be commercially available in early 2024, and this will transform the routine ability to monitor accurately deep responses in myeloma.
And so, these are to test mass spectrometry, a next generation flow that you need to look out for.
The bottom line is that for now, not much has changed. However, by the middle of next year into 2020-2025, the introduction of mass spec and NGF can really transform the way that we accurately monitor and follow along with all of the new treatments which are also being introduced in the same time frame.
Professor of Medicine, Hematologist/Oncologist, and Honoree MD at the University of Brussels, Dr. Brian G.M. Durie is a co-founder of the IMF.
