What Factors Determine If I Have High-Risk Myeloma?

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Before making treatment decisions for multiple myeloma, it’s important to determine your disease’s risk level. How does this change the course of treatment? Renowned myeloma expert Dr. Rafael Fonseca, from the Mayo Clinic in Arizona, discusses risk stratification and explains how high-risk patients are identified and treated. How are high- and low-risk patients different? Dr. Fonseca also discusses features of the disease, specific genetic changes and explains what translocations are. Watch now to learn more.

This town meeting is sponsored by Amgen, Janssen Pharmaceuticals and Adaptive Biotechnologies. It is produced by Patient Power in partnership with Winship Cancer Institute of Emory University.

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Produced in association with Winship Cancer Institute

Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jack Aiello:

Now, there are many ways in which you can measure this.  There are many reasons why one may be at the high risk for having complications or problems, but usually what we're doing here is we're referring to the myeloma cells themselves, and what we really are saying is we're referring to their genetic makeup.   

I think many of you know we always talk about the genetics in myeloma, which, by the way, these are genetic changes that only occur on those myeloma cells.  These are not changes that exist anywhere else in your body.  As a consequence nothing to be worry about, say, passing it from one generation to the next.  These are very specific genetic changes that happen in those myeloma cells, little typos or hiccups, if you may, that those cells have.   

We have multiple ways of testing this.  I don't think probably it's going to be very good to go through all the technicalities, but certainly there's a few factors.  We've done this mostly through a test called FISH, that there's two translocations, t(4;14) 14;16, and loss of what we call p53 or 17p deletion that kind of raise little bit of more extra awareness on our part to say we may need to approach this different.  

That's why we talk about high risk.  At the end of the day it just means that it's a myeloma that can adapt a little bit more, and because they can do that they can sometimes overcome some of the effects of chemo.  So we're more insistent and more intense in how we provide treatments for patients with high-risk disease.   

Chromosome 14 contains the genes that make the immunoglobulins, the main part of the immunoglobulins, what they call the heavy chain.  So to work normal plasma cells, as Dr. Kaufman was saying, is a process where they're always editing, cut and paste, cut and paste, cut and paste. Every now and then if one of those cuts is not pasted in the right way, it's pasted maybe in the wrong chromosome, that's what we call a translocation.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on November 7, 2018