Older Adults at High Risk for Multiple Myeloma Precursor May Benefit from Screening

Older individuals who are black or have immediate family with current or past blood cancer are at a higher risk of multiple myeloma precursor conditions and may benefit from periodic screening and early intervention that might prevent the disease, according to study results presented at the American Society of Hematology Annual Meeting and Exposition.

The study was the largest screening study to date in the United States for individuals at high risk for multiple myeloma.

“We know that in cancers such as breast cancer and lung cancer, screening, early detection, and early intervention can make a difference in patient survival,” Irene Ghobrial, MD, of the Dana-Farber Cancer Institute in Boston, said in a statement. “We have shown for the first time that with highly sensitive screening techniques it may eventually be possible to make a difference in the survival of people at elevated risk for multiple myeloma.”

A precancerous condition called condition called monoclonal gammopathy of undetermined significance (MGUS) carries a 1% risk annually of progressing to multiple myeloma. MGUS causes moderately elevated blood levels of monoclonal proteins, or M proteins, made by plasma cells.

MGUS has no signs or symptoms and physicians usually do not routinely screen individuals for it, Ghobrial said.

A previous study estimated the 3% of Americans aged 50 years and older have MGUS. However, the study included predominantly individuals of European descent.

No other studies to date have looked at the prevalence of MGUS for individuals of African descent and those with a family history of blood cancers, according to the statement.

The PROMISE study was launched in 2019 and aims to enroll 30,000 individuals aged 40 to 75 years, who are at above-average risk for multiple myeloma, because they are black or have a child, parent, or sibling, with a history of multiple myeloma or another blood cancer.

In the study, the investigators reported interim screening findings for 7622 participants, including 2439 black individuals.

Study participants provided a blood sample that was tested for MGUS using both conventional and newer high-sensitivity techniques.

All PROMISE study participants who test positive for MGUS are referred to a medical specialist in the treatment of blood cancers for further testing and follow-up.

Investigators identified and screened black individuals who had contributed blood samples to the Mass General Brigham Biobank, a large biological specimen repository, in Boston Massachusetts.

“Using screening techniques that are currently available in doctors’ offices, we show that the prevalence of MGUS in a high-risk population over age 50 – black people and people who have a first-degree relative with a blood cancer – is twice as high as in the general United States population,” Ghobrial said.

“Using a novel, high-sensitivity screening technique [mass spectrometry], we detected MGUS in 14% of participants. And when we fully employ the capability of mass spectrometry to detect even minute amounts of M-protein in the blood, we can detect the protein in 42% of the high-risk population over age 50,” Ghobrial said.

There were up to 10 years of follow-up data for this cohort.

When the follow-up data from individuals whose samples came from the Biobank was examined, investigators found that, after a median of 4.5 years of follow-up, those with any level of M-proteins had negative health effects, seen as a slightly higher mortality rate from any cause than individuals who had no M-proteins in their blood.

This suggests that individuals with M-proteins are at risk for other conditions, including other blood cancers and heart attacks, as well as multiple myeloma, Ghobrial said.

Investigators hope that the PROMISE study will help identify the factors that contribute to the development of MGUS, cause MGUS to progress to overt cancer, and result in negative health effects for individuals who have any level of M-proteins in their blood.

Reference

Older adults at high risk for multiple myeloma precursor condition may benefit from screening. American Society of Hematology. News release. December 11, 2021. Accessed December 13, 2021. Email.