A new rapid test is being developed that can monitor myeloma patients for signs of disease progression, potentially replacing current techniques which require a bone marrow biopsy.
The blood test may require only one drop of blood, and measures molecules produced by cancerous cells in the bone marrow.
Because of improvements to treatment, more patients with multiple myeloma are reaching a state of minimal residual disease. However, current methods to monitor whether the myeloma cells are growing again rely upon bone marrow punctures, which are unpleasant and invasive procedures for patients. What’s more, they may miss myeloma cells and give an inaccurate picture of disease progression.
“The disease is found almost everywhere in the bone marrow, but in some areas there are more cancerous cells than in other areas,” said Dr Hans Jacobs of Radboud University in the Netherlands. “So, if you take a biopsy where there are fewer cancer cells, the test result does not accurately reflect the real situation."
Dr Jacobs and colleagues wanted to develop an alternative, based upon looking for specific 'fingerprints' of disease progression in the peripheral blood.
Myeloma cells produce abnormal antibodies called M-proteins, which are unique to each patient. In this study, the team used a database of 609 patients to identify unique genetic code within the most abundant myeloma cell clone. Using computers, they predicted the unique peptides which would be created from cutting up the M-protein produced by this clone, which would act as a ‘clonal fingerprint’ for the patient’s disease detectable in the blood.
They then successfully confirmed the reliability of these clonal fingerprints for monitoring disease progression, using serial samples from patients whose disease had progressed.
“We demonstrated that the most abundant clone harboured a unique clonal molecular fingerprint,” they reported in the journal Clinical Chemistry recently.
“Furthermore, the clonal immunoglobulin gene fingerprints remained stable during multiple myeloma disease progression.”
Co-author Pieter Langerhorst added: "We were able to use an international database of more than 600 multiple myeloma patients. In all patients we were able to find a suitable patient-specific barcode, making our new blood test applicable in every patient.
“This is beyond our expectations. With this study, we are taking an important step towards personalised diagnostics for patients with multiple myeloma.”
Langerhorst P, Brinkman AB, VanDuijn MM, Wessels HJCT, Groenen PJTA, Joosten I, van Gool AJ, Gloerich J, Scheijen B, Jacobs JFM. (2021) “Clonotypic Features of Rearranged Immunoglobulin Genes Yield Personalized Biomarkers for Minimal Residual Disease Monitoring in Multiple Myeloma.” Clinical Chemistry, doi: 10.1093/clinchem/hvab017/
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