Dr Zonder on the Importance of Early Screening for Myeloma Among High-Risk Patients

“We may be heading into an era where we have identified patient populations that actually could benefit from screening for [multiple myeloma].”

Jeffrey Zonder, MD, leader of the Multiple Myeloma Sub-Committee at Barbara Ann Karmanos Cancer Institute and a professor of medicine in the Department of Hematology and Oncology at Wayne State University School of Medicine, discussed the importance of targeted, multiple myeloma screening initiatives in high-risk populations, as highlighted by the ongoing PROMISE study (NCT03689595).

Although formal screening recommendations for multiple myeloma have not yet been established, research efforts such as the PROMISE study aim to define which populations may benefit most from early detection strategies, Zonder began. The trial included patients older than 30 years of age who are either of African descent or have a first-degree relative with a plasma cell disorder. These 2 groups have a known increased risk for monoclonal gammopathy of undetermined significance (MGUS) and related conditions, Zonder noted.

Preliminary results from the study demonstrated that over 10% of participants screened were found to have a plasma cell disorder, including MGUS. Importantly, this elevated incidence was observed even among younger individuals, underscoring the potential utility of screening strategies outside of traditionally older populations, Zonder detailed. He added that earlier identification of precursor conditions could enhance risk stratification and guide monitoring, especially given the stepwise progression that may occur from MGUS to smoldering myeloma, and ultimately symptomatic multiple myeloma.

Zonder emphasized that the PROMISE study reflects a broader movement toward risk-adapted screening models in hematologic malignancies. By focusing on high-risk cohorts, researchers may be able to detect disease earlier, inform patients about their risks, and potentially alter the course of disease through timely surveillance or early therapeutic intervention.

Although widespread screening of the general population is unlikely to be warranted, the data emerging from PROMISE suggest that certain individuals may benefit from targeted screening based on ancestry and family history. Continued follow-up and future data from this study will be critical for establishing the long-term effects of early detection on patient outcomes in multiple myeloma, Zonder concluded.