Multiple Myeloma - Cerba Research

What Is Multiple Myeloma?

Multiple myeloma (MM), although rare (1), is the second most common blood cancer worldwide (2). It originates from bone marrow plasma cells, thus impacting regions where bone marrow is active, such as bones, blood, kidneys, and the immune system (2).

Multiple myeloma is complex, as it’s difficult to diagnose properly and has a complex guidelines schema (3, 4, 5). Cerba Research has you covered with a wide range of international multiple myeloma working group (IMWG) offerings that utilize cutting-edge techniques. As one of our sponsors said, “consistency of data can make or break an asset, which is why we prefer partnering with Cerba Research for MM IMWG testing.” Contact us to find out.

Cerba Research Multiple Myeloma Services

Our multiple myeloma specialists support a wide range of MM studies from discovery / preclinical (data not shown) to phase III registration trials and beyond. Most (95%+) of our projects include specialty testing, such as, but not limited to, flow cytometry (FCM), cytogenetics, qPCR, ddPCR, NGS comprehensive myeloma panels, 250+ IHC simplex and multiplex protocols, cytogenetics, and more.

Our Experience In The Multiple Myeloma Landscape

60+

MM trials in the past 10 years

95%+

Of MM trials with specialty testing(s) and 45+ PBMC isolation network labs

176

Genes with our Cerba NGS extended panel for hematological malignancies

250+

Histopathology analysis with markers such as CD138, kappa, lambda run in CLIA accredited laboratories

Our Areas Of Expertise In Multiple Myeloma

Did you know that we can cover a wide range of multiple myeloma biomarkers and clinical features? Check out our mapping exercise by select MM features against our Cerba Research offerings (2-5).

MM Biomarkers	Most Commonly Deployed Technics	Additional Assays	Cerba Research Offerings
Structural (unbalanced)	Cytogenetics, FISH	OGM, NGS	Cytogenetics, FISH
Structural (balanced)	Cytogenetics, FISH	OGM, NGS	Cytogenetics, FISH
TP53	FISH, NGS		FISH, PCR, NGS
CXCR4	NGS		NGS
MYD88	PCR		ddPCR, NGS

MM Biomarkers

Most Commonly Deployed Technics	Cytogenetics, FISH
Additional Assays	OGM, NGS
Cerba Research Offerings	Cytogenetics, FISH

MM Biomarkers

Most Commonly Deployed Technics	Cytogenetics, FISH
Additional Assays	OGM, NGS
Cerba Research Offerings	Cytogenetics, FISH

MM Biomarkers

Most Commonly Deployed Technics	FISH, NGS
Additional Assays
Cerba Research Offerings	FISH, PCR, NGS

MM Biomarkers

Most Commonly Deployed Technics	NGS
Additional Assays
Cerba Research Offerings	NGS

MM Biomarkers

Most Commonly Deployed Technics	PCR
Additional Assays
Cerba Research Offerings	ddPCR, NGS

MM Biomarkers  (CRAB Features)	Details	Assays	Cerba Research Offerings
Increased calcium levels	>11.5 mg/dL	Routine	X
Renal insufficiency	Creatinine >2 mg/dL CrCl <40 mL/min	Routine	X
Anemia	Hb <10 g/dL or 2 g/dL less than normal	Routine	X
Presence of bone lesions	Presence of one or more osteolytic lesions	Skeletal radiography, whole-body MRI or whole-body FDG PET/CT

MM Biomarkers  (CRAB Features)

Details	>11.5 mg/dL
Assays	Routine
Cerba Research Offerings	X

MM Biomarkers  (CRAB Features)

Details	Creatinine >2 mg/dL CrCl <40 mL/min
Assays	Routine
Cerba Research Offerings	X

MM Biomarkers  (CRAB Features)

Details	Hb <10 g/dL or 2 g/dL less than normal
Assays	Routine
Cerba Research Offerings	X

MM Biomarkers  (CRAB Features)

Details	Presence of one or more osteolytic lesions
Assays	Skeletal radiography, whole-body MRI or whole-body FDG PET/CT
Cerba Research Offerings

MM Biomarkers (Slim Features)	Details	Assay	Cerba Research Offerings
% Clonal plasma cells	Sixty%+ clonal plasma cells in BM	% clonal bone marrow plasma cells	X
Free light chain ratio	Ratio of 110+ with the involved FLC ≥ 100 md/dL	Serum FLC assay, along with sPEP, uPEP	X
MRI	1+ focal marrow (non-osteolytic) lesion	MRI

MM Biomarkers (Slim Features)

Details	Sixty%+ clonal plasma cells in BM
Assay	% clonal bone marrow plasma cells
Cerba Research Offerings	X

MM Biomarkers (Slim Features)

Details	Ratio of 110+ with the involved FLC ≥ 100 md/dL
Assay	Serum FLC assay, along with sPEP, uPEP
Cerba Research Offerings	X

MM Biomarkers (Slim Features)

Details	1+ focal marrow (non-osteolytic) lesion
Assay	MRI
Cerba Research Offerings

IMWG MRD Criteria	Details	Most Commonly Deployed	Cerba Research Offerings
Flow MRD-negative	Absence of phenotypically aberrant clonal plasma cells on BMAs	FCM (EuroFlow or validated equivalent)	FCM (EuroFlow)

IMWG MRD Criteria

Details	Absence of phenotypically aberrant clonal plasma cells on BMAs
Most Commonly Deployed	FCM (EuroFlow or validated equivalent)
Cerba Research Offerings	FCM (EuroFlow)

BM=bone marrow; BMA=bone marrow aspirate; ddPCR: digital droplet PCR; FCM=flow cytometry; FISH=fluorescence in situ hybridization; FLC=free ligh chain; Hb: hemoglobin; MM=multiple myeloma; MRD=minimal residual disease; MRI=magnetic resonance imaging; NGS=next-generation sequencing; OGM=optical genome mapping; sPEP=serum protein electrophoresis; uPEP=urine protein electrophoresis

Kappa/Lambda Positivity In Plasma Cell Myeloma

What Is IMWG Recommending For The Diagnosis Of MM Aligned With Cerba Research Offerings?

Complete Blood Count (CBC)

CBC with differential and peripheral blood smear review

Immunoglobulins

Nephelometric quantitation of immunoglobulins

Chemistry Panel

Chemistry panel including calcium and creatinine

Urinalysis

Routine urinalysis, 24h urine collection for proteinuria, eletrophoresis & immunofixation

sPEP

Serum protein electrophoresis, immunofixation

M-component

Quantification of both urine M-component level & albuminuria

References

1. Orphanet: The portal for rare diseases and orphan drugs. URL [https://www.orpha.net].

2. International Myeloma Foundation: What is multiple myeloma? URL [https://www.myeloma.org/what-is-multiple-myeloma].

3. National Comprehensive Cancer Network®: NCCN guidelines, treatment by cancer type. URL [Treatment by Cancer Type (nccn.org)].

4. Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BG, Miguel JF. International Myeloma Working Group updated the criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014 Nov;15(12):e538-48. doi: 10.1016/S1470-2045(14)70442-5. Epub 2014 Oct 26. PMID: 25439696.

5. Kumar S, Paiva B, Anderson KC, Durie B, Landgren O, Moreau P, Munshi N, Lonial S, Bladé J, Mateos MV, Dimopoulos M, Kastritis E, Boccadoro M, Orlowski R, Goldschmidt H, Spencer A, Hou J, Chng WJ, Usmani SZ, Zamagni E, Shimizu K, Jagannath S, Johnsen HE, Terpos E, Reiman A, Kyle RA, Sonneveld P, Richardson PG, McCarthy P, Ludwig H, Chen W, Cavo M, Harousseau JL, Lentzsch S, Hillengass J, Palumbo A, Orfao A, Rajkumar SV, Miguel JS, Avet-Loiseau H. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016 Aug;17(8):e328-e346. doi: 10.1016/S1470-2045(16)30206-6. PMID: 27511158.