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KOS 2007: Clinical and Pathological Implications of Myeloma Subtypes
By Rafael Fonseca, MD
Rafael Fonseca, MD
Mayo Clinic
Scottsdale, AZ, USA

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Mayo Clinic
Scottsdale, AZ, USA

by Lynne Lederman, PhD

In continuing the theme of this session in which research into the genetics of myeloma is revealing more complexities, Dr. Fonseca discussed how to integrate these findings into the clinic. Classification schemes for risk can be based on biologic classification, which should be stable over time, and describes the pathophysiology and disease progression. This category includes primary and secondary genetic events and gene dysregulation, and may not be of clinical utility. Myeloma can be classified prognostically using baseline features that result in differential response to treatment. This classification can be expected to change over time. For example, although chromosome 13 deletion has been considered to be a poor prognostic factor, novel agents, e.g., bortezomib, may overcome this factor. Most of the predictive studies have been done in patients treated with melphalan and prednisone, so it will be necessary to revisit predictive models with novel therapies. Predictive classifications, e.g., the ability to predict duration of response, incorporates treatment as a variable. Most studies are not powered for the molecular class, and Dr. Fonseca would like to see future trials considering molecular markers. He also suggested that it should be possible to identify those factors associated with the risk of progression of MGUS to multiple myeloma.

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