How we approach smoldering multiple myeloma journal of. Table of contents what you will learn from this booklet 4 monoclonal gammopathy of undetermined significance 5 smoldering multiple myeloma 10 in closing 14 terms and definitions 14. Multiple myeloma mm evolves from a premalignant, asymptomatic precursor stage known as smoldering mm smm 1, 2. Since then, the understanding of prevalence, diagnosis, risk of progression, and possible treatment has greatly increased. The stage of myeloma between mgus and active myeloma is called smoldering multiple myeloma smm, which is characterized by a higher level of mprotein than mgus but with no indicators of. Smoldering multiple myeloma smm is an asymptomatic plasma cell disorder characterized by the presence of. Historically, smoldering myeloma patients have not been put on active treatment because many of them only have a 10% risk per year for the first 5 years of progressing to active myeloma with a cumulative 50% risk. Smm is distinguished from monoclonal gammopathy of undetermined. Smoldering multiple myeloma smm is an asymptomatic plasma cell.
Mm smoldering multiple myeloma is a plasma cell disorder defined by the presence of a. Jan 01, 2005 monoclonal gammopathy of undetermined significance mgus and smoldering multiple myeloma smm are asymptomatic, premalignant disorders characterized by monoclonal plasma cell proliferation in the bone marrow and absence of endorgan damage. Smoldering multiple myeloma increases the risk of developing. Yee, md1,2 the oncology grand rounds series is designed to place original reports published in the journal into clinical context. Myeloma service, memorial sloan kettering cancer center. As another year comes and goes, having a diagnosis of smoldering multiple myeloma makes it a bit challenging as you dont know whether to be happy that you are a year older or that your cancer has not started acting up. This type of cancer produces certain proteins that can be. Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells. Smoldering multiple myeloma blood american society of. When to initiate treatment in smoldering multiple myeloma. Our aim was to investigate in depth the level of clonal heterogeneity of recurrent genetic abnormalities in these conditions. Plasma cells help you fight infections by making antibodies that recognize and attack germs.
Daratumumab monotherapy for patients with intermediate. Intermediaterisk smoldering myeloma, for example, indicates a 50%74% chance of progression to multiple myeloma within 5 years. As another year comes and goes, having a diagnosis of smoldering multiple myeloma makes it a bit challenging as you dont know whether to be happy that you are a year. Smoldering myeloma is a precursor stage of multiple myeloma. Mm the presence of highrisk cytogenetic abnormalities in smoldering multiple myeloma predicts a higher risk for progression to active multiple myeloma. Early treatment of smoldering multiple myeloma multiple. Ola landgren, chief of memorial sloan ketterings myeloma service, explains how molecular profiling is used to analyze the biology of myeloma and personalize care. It reflects a higher level of plasma cells in the bone marrow and a higher level of mprotein in the blood than does mgus. Smoldering multiple myeloma smm is an asymptomatic plasma cell proliferative disorder associated with risk of progression to.
Smoldering multiple myeloma increases the risk of developing multiple myeloma. The primary abnormalities inducing the transformation of a normal plasma cell to a pathologic plasma cell are already present in smoldering multiple myeloma and mgus. Pdf how i treat smoldering multiple myeloma ola landgren. New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow. Smoldering mm is present when the serum m protein concentration is 3 gdl or the bone marrow plasma cell concentration is 10% but there is no evidence of endorgan damage. The risk of progression from mgus to myeloma is 1% per year. Mgus transforms to multiple myeloma at the rate of 1% to 2% per year, and almost all cases of multiple myeloma are preceded by mgus.
Yee, md1,2 the oncology grand rounds series is designed to place original reports published in the journal into. The nccn guidelines for multiple myeloma provide recommendations for diagnosis, workup, treatment, followup, and supportive care for patients with monoclonal gammopathy of renal. Risk stratification of smoldering multiple myeloma. Multiple myeloma brings with it complications of bone fractures, low blood counts, high calcium levels and kidney problems. This type of cancer produces certain proteins that can be measured in both blood and urine.
Apr 20, 2018 smoldering multiple myeloma smm was first defined by kyle and greipp in 1980. Smoldering multiple myeloma smm is an asymptomatic precursor stage of multiple myeloma mm characterized by clonal bone marrow plasma cells bmpc. These include blood, urine, bone marrow, and imaging tests. The risk of progression to active myeloma among patients with.
Follow up from diagnosis of smoldering multiple myeloma years percent progressing pcli myeloma patients while working toward prevention and a cure. Although patients are at variable risk for progression to mm, there is currently. Randomized trial of lenalidomide versus observation in smoldering multiple myeloma. Jun 12, 2018 the term smoldering multiple myeloma smm was first introduced in 1980 to identify a group of six patients with 10% or more plasma cells pcs in the bone marrow bm and no organ damage at. Smouldering myeloma with an increasingly abnormal serum free light chain flc ratio is associated with a higher risk for progression to active multiple myeloma. Multiple myeloma features low blood counts in multiple myeloma, the overgrowth of plasma cells in the bone marrow can crowd out normal bloodforming cells, leading to low blood counts2. Smoldering myeloma is a slowgrowing type of multiple myeloma or myeloma plasmacytoma a rare form of myeloma in which there is only one tumor that is not causing the. Multiple myeloma diagnosis and treatment mayo clinic. There have been major advances in the diagnosis, prognosis, and management of smm in the last few years. Patients may present with bone pain or with symptoms that are often nonspecific, such as nausea. Monoclonal igg monoclonal iga monoclonal igd monoclonal kappa free light chain monoclonal lambda free light chain differential diagnosis. The progression from mgus to smoldering myeloma and. Because smoldering myeloma is expected to progress to multiple myeloma, a patients risk level indicates how soon this progression is likely to occur. To extend our knowledge of mgus to structural chromosomal abnormalities, we have performed fluorescence in situ hybridization experiments with probes directed to the 14q32 and q14 chromosomal regions in 100 patients with either mgus or smoldering multiple myeloma smm.
Genetic aberrations detected in multiple myeloma mm have also been reported in the premalignant conditions monoclonal gammopathy of undetermined significance mgus and. Genetic aberrations detected in multiple myeloma mm have also been reported in the premalignant conditions monoclonal gammopathy of undetermined significance mgus and smoldering mm smm. The term smoldering multiple myeloma smm was first introduced in 1980 to identify a group of six patients with 10% or more plasma cells pcs in the bone marrow bm and no organ. The oncology grand rounds series is designed to place original reports published in the journal into clinical context. The stage of myeloma between mgus and active myeloma is called smoldering multiple myeloma smm, which is characterized by a higher level of mprotein than mgus but with no indicators of active myeloma. Some early cancers may have signs and symptoms that can be noticed, but that is not always the case. What is new in mgus and smoldering multiple myeloma.
Smoldering multiple myeloma smm is diagnosed in persons who meet the following criteria. Individuals diagnosed with this premalignant disorder develop multiple myeloma at a rate of 10% per year for the first 5 years, 3% per. This can cause anemia a shortage of red blood cells. If you develop signs and symptoms or your multiple. New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow plasma cells. These nccn guidelines insights highlight some of the important updates and changes in. Smoldering multiple myeloma smm is a precursor condition associated with multiple myeloma.
Multiple myeloma early detection, diagnosis, and staging. Jan 26, 2009 smoldering myeloma is a slowgrowing type of multiple myeloma or myeloma plasmacytoma a rare form of myeloma in which there is only one tumor that is not causing the symptoms or damage that is. Immunotherapy for smoldering myeloma md anderson cancer. Jun 12, 2019 multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Smoldering multiple myeloma smm is an asymptomatic plasma cell disorder characterized by the presence of one or both features of serum mprotein. Genomic profiling of smoldering multiple myeloma identifies patients. The nccn guidelines for multiple myeloma provide recommendations for diagnosis, workup, treatment, followup, and supportive care for patients with monoclonal gammopathy of renal significance, solitary plasmacytoma, smoldering myeloma, and multiple myeloma. Smm is distinguished from monoclonal gammopathy of undetermined significance by a much higher risk of progression to multiple myeloma mm. Updates in managing smoldering multiple myeloma vumedi. The risk of progression to active multiple myeloma mm is not uniform, and several markers are useful for identifying patients at high risk of progression. These proteins show up before a person has any symptoms of cancer. Mgus is found in about 3% of individuals over 50 years of age and.
Follow up from diagnosis of smoldering multiple myeloma years percent progressing pcli smoldering multiple myeloma smm, a term coined in 1980 by professor emeritus philip greipp of the mayo clinic, describes an asymptomatic intermediate stage between mgus and active myeloma. Mgus is followed by smoldering multiple myeloma smm, an asymptomatic clonal plasma cell disorder 17, 18, and eventually by mm. When does smoldering myeloma become active myeloma. Pdf treatment for highrisk smoldering myeloma researchgate. Jun 24, 2017 smoldering multiple myeloma smm is an asymptomatic plasma cell disorder characterized by the presence of.
If you have multiple myeloma but arent experiencing any symptoms also known as smoldering multiple myeloma, you may not need treatment. The stage of myeloma between mgus and active myeloma is called smoldering multiple myeloma smm, which is characterized by a. Smoldering myeloma is a heterogeneous clinical entity where a subset of patients has an indolent course of disease that mimics monoclonal. Smoldering multiple myeloma is an asymptomatic proliferative disorder of plasma cells with a high risk of progression to symptomatic, or active, multiple myeloma. How i treat smoldering multiple myeloma blood american society. Smoldering multiple myeloma mateos 2015 hematological. Lenalidomide plus dexamethasone for highrisk smoldering multiple myeloma. Monoclonal gammopathy of undetermined significance mgus and smm are precursor conditions for multiple myeloma mm. Smm is distinguished from monoclonal gammopathy of undetermined significance by a much higher.
Laboratory screening tests for suspected multiple myeloma. However, your doctor will regularly monitor your condition for signs that the disease is progressing. Historically, smoldering myeloma patients have not been put on active treatment because many of them only have a 10% risk per year for the first. All myeloma patients have mgus before they progress to active myeloma, but only 20% of people diagnosed with mgus eventually get myeloma. Smoldering multiple myeloma smm solitary plasmacytoma light chain amyloidosis. Smoldering multiple myeloma smm is an early or asymptomatic no symptoms myeloma that is not causing any problems. Monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Multiple myeloma early detection, diagnosis, and staging cancer. The current standard of care for people with smoldering multiple myeloma smm has been to wait and watch for signs of disease progression to multiple myeloma a cancer of the plasma cells. Because patients with smm lack symptoms, the condition is typically discovered when m protein is found in blood or urine lab tests. In 2014, the international myeloma working group determined that patients with ultrahighrisk smoldering multiple.
Monoclonal gammopathy of undetermined significance mgus and smoldering multiple myeloma smm are asymptomatic, premalignant disorders characterized by monoclonal plasma cell. The term smoldering multiple myeloma smm was first introduced in 1980 to identify a group of six patients with. If doctors suspect that you have multiple myeloma, you may undergo a variety of tests. Smoldering multiple myeloma smm smoldering multiple myeloma smm is an early or asymptomatic no symptoms myeloma that is not causing any problems. Smoldering multiple myeloma smm is an asymptomatic clonal plasma cell disorder. Clinical course and prognosis of smoldering asymptomatic. Multiple myeloma mm is an incurable plasma cell malignancy that arises from two precursor states. Multiple myeloma is characterized by an increase of abnormal plasma cells in the bone marrow and monoclonal protein in the serum, often with osteolytic bone lesions. Cure 5 what you will learn from this booklet the imfs understanding series of booklets is designed to acquaint you with treatments and supportive care. May 14, 2015 smoldering multiple myeloma smm is an asymptomatic clonal plasma cell disorder. Immunotherapy for smoldering myeloma md anderson cancer center. Smoldering multiple myeloma smm is an early precursor to a rare blood cancer known as multiple myeloma, which affects plasma cells. Vumedi webinars updates in managing smoldering multiple myeloma syllabus. Howweapproach smoldering multiple myeloma noopur raje, md1,2 and andrew j.
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