Transcript:

This week’s “Ask Dr. Durie” comes from a patient who wants to know: “Will it really be possible to prevent myeloma?” And obviously, this is something that has been discussed a lot in the last two, three, four years. But clearly the tone of this patient is rather skeptical, thinking that clearly, it’s going to be quite difficult to prevent myeloma. 

Well, the answer to this question is that it probably will be possible to prevent myeloma. But the only question is, when and how? And, these are really key things. And so, I can say right off, that probably we won’t be able to prevent myeloma tomorrow, but we are definitely on track to see ways to preventing myeloma in the coming years. 

And so, the first part to prevention is to understand that active multiple myeloma is always proceeded by MGUS, monoclonal gammopathy of undetermined significance. And so, there is a pre-myeloma stage. And so, to prevent myeloma, the first question is, “What causes MGUS?”

And so, this is a question that through the Black Swan Research Initiative®, we are attempting to answer in our Iceland program, the iStopMM initiative. In which, we are evaluating all the patients in Iceland who have developed MGUS. And at this point, from our screening of the population, over 90,000 of the Iceland population have evaluated thus far. It’s estimated that we will identify approximately 4.000 new patients with MGUS. And by analyzing these individuals, we will get a good analysis of what is triggering this MGUS? And is there a genetic predisposition to developing MGUS? 

The second type of prevention is really not full prevention, but it is to prevention the progression of MGUS into active myeloma. And, this is something that is already being investigated in clinical trials. A variety of single agents have been tested including Revlimid®, Revilimid+dex, and even daratumumab to see if it will prevent the development of myeloma.  What we know so far, is that it can certainly delay the onset but don’t really have a good sense that it can truly, fully prevent the active myeloma phase.

And so, THE BOTTOM LINE is that there is a high likelihood that in the coming years that we will be able to both prevent the development of MGUS and also, to prevent or delay the transition from MGUS to active myeloma. But for the time being, these are areas of active research and areas of which I’ll be glad to give future updates as we learn more and can offer some suggestions of how to be starting to prevent MGUS and the transition to active myeloma. 

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®.