Dr Zonder on the Importance of Personalized Medicine in Multiple Myeloma

"The first question we ask is, ‘Is this patient a transplant candidate?’ We ask that based on a variety of factors,mostly the patient's overall health status, and it often has less to do with molecular characteristics of the disease than other health characteristics of the patient globally."

Jeffrey Zonder, MD, leader of the Multiple Myeloma Sub-Committee at Barbara Ann Karmanos Cancer Institute and professor of medicine in the Department of Hematology and Oncology at Wayne State University School of Medicine, discussed the role of personalized medicine in the treatment of multiple myeloma, emphasizing the importance of individualizing therapy based on patient-specific characteristics.

One of the initial decisions in the treatment algorithm is determining whether a patient is eligible for autologous stem cell transplant (ASCT), Zonder explained. This decision is primarily informed by the patient’s overall health status, functional reserve, and comorbid conditions, rather than the molecular features of the disease. Factors such as age, cardiac function, renal function, and performance status are critical in guiding the intensity of frontline treatment.

In addition to transplant eligibility, treatment selection often incorporates a patient’s comorbidities and medication tolerance, Zonder continued. For example, in patients with preexisting peripheral neuropathy—particularly from diabetes—bortezomib (Velcade) may be avoided or dose-reduced to limit neurotoxicity. Similarly, in patients with a history of fluid retention, dexamethasone doses may be modified to minimize treatment-related complications.

Zonder also addressed how risk stratification influences maintenance strategies. Although not always defined by a single genetic alteration, patients with high-risk cytogenetics or clinical features may benefit from intensified maintenance regimens. In these cases, clinicians may opt for doublet or triplet maintenance approaches, rather than a single-agent therapy, to achieve deeper and more durable remissions.

Personalized medicine in multiple myeloma encompasses more than genomic profiling, Zonder emphasized. It requires a holistic assessment of the patient’s clinical status, comorbidities, treatment preferences, and tolerability. This approach ensures that therapeutic decisions are tailored to each patient's unique clinical context and long-term goals of care.