Discussing the Relevance of Urine Studies in Myeloma With Kelsey Natsuhara, MD

At the recent American Society of Hematology (ASH) Annual Meeting, Kelsey Natsuhara, MD, a Fellow in Hematology and Oncology at the University of California, San Francisco, sat down with Oncology Data Advisor and ConveyMED to discuss her presentation regarding the relevance of urine studies in myeloma patients undergoing transplantation.

This podcast episode was recorded live by Oncology Data Advisor and ConveyMED at the 2022 ASH annual meeting in New Orleans.

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, I’m with Kelsey Natsuhara, who is here to discuss her study that she’s presenting here at ASH. Thank you for joining us.

Kelsey Natsuhara, MD: Thanks so much for having me. I really appreciate it.

Oncology Data Advisor Yes. So, would you like to tell us about yourself and what you do?

Dr. Natsuhara: Sure. I’m a first-year Hematology and Oncology Fellow at the University of California, San Francisco (UCSF), and I am interested in health disparities research and health services research. This was a project that I got involved with in residency, and I’m really excited to be presenting it at ASH.

Oncology Data Advisor: That’s great. I’d love to hear more about your study about Significance of the Pee-Value: Relevance of Urine Studies for Patients with Myeloma Undergoing Transplantation. Would you like to tell us about this?

Dr. Natsuhara: Yes, absolutely. So, our study is looking at the relevance of 24-hour urine testing in myeloma response assessment, prior to transplant. This is a test that is really challenging and cumbersome for patients to collect. It requires them to collect their urine for 24 hours—carrying a jug around with them, storing it in the refrigerator next to their milk and their eggs, and collecting their urine for a full 24 hours.

This is done twice, typically, for patients with myeloma. They have to do it once at the time of diagnosis, and then again right before they get their stem cell transplant. That, in particular, is a time that’s really full of other concurrent testing requirements. As the field has progressed, and as we’ve developed new assays to look at response into measure of disease within multiple myeloma—particularly thinking about things like serum free light chains—I think many in the field wonder whether or not 24-hour urine testing requirements are still necessary.

In the real-world setting, this test is often omitted, but it is still included in the International Myeloma Working Group (IMWG) criteria for response assessment. So, our group really wanted to understand the impact of urine testing, and whether it actually made a difference in response assessments for patients.

We looked at a cohort of patients from UCSF who were undergoing transplant for myeloma between 2016 and 2019. We had 281 patients in our study, and we looked at the responses with and without urine. We used traditional IMWG grading response criteria, and then what we call urine-free criteria, where we can systematically drop the urine testing requirement to achieve any response depth.

What we found is that only 4% of patients had their response assessment change, what we call the reclassification rate. We had hypothesized that this rate would change by no more than 10%, which we felt was a clinically insignificant level. And so, we were far under what we actually hypothesized, and I think it just goes to show that this is a test in oncology that is probably unnecessary. It’s pretty burdensome for patients and it actually doesn’t really impact clinical outcomes.

Oncology Data Advisor: Great. Thanks for the sharing. Do you have any further research for this?

Dr. Natsuhara: Yes. This was a small, retrospective study that we did at UCSF in our cohort. We’re really interested in expanding this type of research into larger groups and to validate it. I think, particularly, the next step is looking at whether or not urine-free versus traditional IMWG response criteria performs better and is better predictive of the biological response and looking at outcomes like progression-free survival. We just didn’t have the power in our study to look at that outcome, given how few patients’ response assessments changed. And so, that’s work that one of my mentors, Dr. Rahul Banerjee, is working on, in validating this work in a larger cohort.

Oncology Data Advisor: Great! Anything else you’d like to share about either your research, or about other interesting research you’ve seen presented here?

Dr. Natsuhara: I think that it’s so important as the field progresses—and we have all of these options for treatment and for testing—to really be thoughtful about the way that it’s implemented for patients, and to really think about the burden that it places on patients’ time and resources.

I think this is just one example of a test that we do in medicine that may not impact outcomes. I think it is really important to think about quality of life, and also to think about it in terms of access to care. I think for a lot of patients, not having a urine test can actually preclude them from participating in a research study or a clinical research trial. I also think from an equity standpoint, this is a much harder test for women to complete than for men. And so, though small, I think it has the opportunity to have a big impact on how we practice medicine.

Oncology Data Advisor That’s fantastic. Thanks so much for sharing.

Dr. Natsuhara: Yes, of course.

Thank you for listening to this podcast, recorded live at the 2022 ASH Annual Meeting by Oncology Data Advisor and ConveyMED. For more expert perspectives on the latest in cancer research and treatment, be sure to subscribe to the podcast at conveymed.io and OncData.com. Don’t forget to follow us on social media for news, exclusive interviews, and more.

About Dr. Natsuhara

Kelsey Natsuhara, MD, is a Hematology and Oncology Fellow at the University of California, San Francisco. Her research interests include health service research and disparities experienced by patients in oncology. Dr. Natsuhara is active in clinical trials and has published as an author or coauthor of a plethora of studies.

For More Information

Natsuhara K, Huang CH, Knoche J, et al (2022). Significance of the pee-value: relevance of urine studies for patients with myeloma undergoing transplantation. Blood, 140(suppl_1):7910-7912. DOI:10.1182/blood-2022-155906

Transcript edited for clarity. Any views expressed above are the speaker’s own and do not necessarily reflect those of Oncology Data Advisor. 

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