A study, funded by Myeloma UK, has demonstrated that neutral tumour evolution in myeloma is associated with poorer prognosis. Neutral evolution is the term used to describe evolution caused by random genetic mutations and are normally considered to be neither beneficial nor detrimental to survival. However, in this study, such tumours conferred a worse prognosis in patients receiving treatment with immunomodulatory drugs.

Researchers at The Institute for Cancer Research, London analysed whole exome sequencing tumour data from patients participating in the Myeloma XI and CoMMpass trials. The results, published in Blood, showed that neutral evolution was evident in 20% of tumours analysed from the Myeloma XI trial, and in 17% from the CoMMpass trial. In both trials, patients with neutral tumour evolution who received immunomodulatory drug treatment demonstrated significantly worse progression-free and overall survival.

The authors concluded that knowledge of the evolutionary dynamics of myeloma has potential for optimising treatment choices and predicting patient outcome.

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