Mass Spectrometry-Based Monitoring Technique to Predict and Identify Early Myeloma Relapse

Image: QIP-MS could predict and detect myeloma relapse earlier compared to currently used techniques (Photo courtesy of Adobe Stock)

Myeloma, a type of cancer that affects the bone marrow, is currently incurable, though many patients can live for over 10 years after diagnosis. However, around 1 in 5 individuals with myeloma have a high-risk form of the disease, which is marked by an earlier relapse following initial treatment. This leads to a shorter survival period, typically just 2-3 years. A key challenge for clinicians is predicting when relapse will occur so that patients can be treated with effective alternative therapies before the disease advances. Now, a research team is evaluating a new mass spectrometry-based monitoring technique to determine its ability to predict and identify early relapses of the disease.

The introduction of more effective therapies over the past two decades has significantly improved survival rates for myeloma patients. The most recent generation of myeloma drugs includes therapeutic monoclonal antibodies (t-mAb), which have shown remarkable efficacy. However, these drugs can interfere with traditional electrophoretic methods used to measure the patient’s monoclonal immunoglobulin (M-Ig), making patient monitoring more challenging. Therefore, alternative laboratory methods that address the limitations of these conventional approaches are needed. Oxford University Hospitals (Oxford, UK), in collaboration with other institutions, is leading the investigation into a new monitoring method known as quantitative immunoprecipitation-mass spectrometry (QIP-MS). The research team will assess whether QIP-MS can predict and detect relapse earlier than current methods in patients with high-risk myeloma participating in the Myeloma XV RADAR trial. This trial involves analyzing bone marrow samples to determine the most effective treatments for myeloma and aims to measure small amounts of myeloma cells, referred to as minimal residual disease (MRD), that may persist after initial treatment.

Previous research has shown that QIP-MS is clinically useful as a first-line screening tool for investigating monoclonal gammopathy, offering higher sensitivity and resolution than the standard methods currently in use. Serum or urine protein electrophoresis (SPEP or UPEP) and immunofixation electrophoresis (SIFE or UIFE) are commonly used to detect M-proteins in multiple myeloma patients. However, SPEP and SIFE are not sufficiently sensitive to detect low levels of M-proteins, which may still be clinically significant. QIP-MS, on the other hand, allows for the identification of M-proteins in patients with multiple myeloma who are otherwise in complete remission, and could be ideal for evaluating MRD in peripheral blood. One significant advantage of QIP-MS is that it uses blood samples rather than bone marrow, which, if proven to be more sensitive, would reduce the need for painful procedures during regular monitoring for patients.