Ajai Chari, MD, PhD

Ajay Chari, MD, professor of medicine, director of clinical research in the multiple myeloma program, and hematologic oncologist at Mount Sinai Hospital, discusses new blood testing options for patients with multiple myeloma.

According to Chari, ongoing research on blood tests has the potential to reduce the need for invasive bone marrow biopsies to diagnose disease and monitor the efficacy of treatment.

Mass spectroscopy is being investigated to replace serum protein electrophoresis to identify the isotype of monoclonal immunoglobulin or M-protein. Due to the use of monoclonal antibodies as therapy for multiple myeloma, traditional methods are not able to distinguish residual protein from the disease from that of the drug. It is also important to be able to detect the presence of disease at lower levels to predict relapse.

Another test is soluble B-cell maturation antigen (BCMA), which can also determine whether treatment is effective rapidly by measuring the level of BCMA protein in the blood. This test is effective even in patients whose M-protein cannot be detected.

Chari suggests that with these tests plus existing blood and urine tests, far fewer patients will require bone marrow biopsies, and patients will prefer less invasive options.

 What we're all really excited about is, what patient is going to raise their hand for a bone marrow when you can do it with blood, right? And the blood tests are really exciting. We have mass [spectroscopy], which is going to potentially pick up disease…to pick up each isotype. And what that test will also allow us to help distinguish is, in the era of immunotherapy, how much of that residual protein we're detecting in the blood is coming from the drug versus the disease, because sometimes you may not be able to appreciate that. So there may be patients who look like they have a little bit of disease, but it's all just the exogenous drug that we're giving them, because myeloma is an antibody-based disorder. So that will be really exciting.

There's also soluble BCMA, which will also be able to pick up these things. So I think, between the current blood and urine tests, and if we add those 2 tests, hopefully we can decrease the number of patients that need a marrow, right? Because if you can detect it in the blood, you don't need to go to the marrow, and you save the patient an invasive procedure.

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Ajay Chari, MD, discusses new blood testing options for patients with multiple myeloma. 

Ajai Chari, MD, PhD | Authors

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New Blood Tests Reduce Need for Bone Marrow Biopsy in Multiple Myeloma