Smoldering multiple myeloma current treatment algorithms

• Type of Material: Article
• Authors: Vincent S Rajkumar, Mayo Clinic; Shaji Kumar, Mayo Clinic; Sagar Lonial, Emory University; Maria Victoria Mateos, University Hospital of Salamanca
• Language: English
• Date: 2022-09-05
• Publisher: SPRINGERNATURE
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1038/s41408-022-00719-0
• Title of Journal or Parent Work: BLOOD CANCER JOURNAL
• Volume: 12
• Issue: 9
• Start Page: 129
• End Page: 129
• Keywords: PROGRESSION; UNDETERMINED SIGNIFICANCE MGUS; STAGE-I; LENALIDOMIDE PLUS DEXAMETHASONE; Oncology; Hematology; THALIDOMIDE; ZOLEDRONIC ACID; LONG-TERM; RISK; Life Sciences & Biomedicine; TERM-FOLLOW-UP; Science & Technology; MONOCLONAL GAMMOPATHY
• Research Categories: Health Sciences, Oncology

Abstract

Smoldering multiple myeloma (SMM) is an asymptomatic condition that occupies a space between monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) along the spectrum of clonal plasma cell proliferative disorders. It is not a biologic intermediate stage between MGUS and MM, but rather represents a heterogeneous clinically defined condition in which some patients (approximately two-thirds) have MGUS (pre-malignancy), and some (approximately one-third) have MM (biologic malignancy). Unfortunately, no single pathologic or molecular feature can reliably distinguish these two groups of patients. For purposes of practice and clinical trials, specific risk factors are used to identify patients with SMM in whom malignant transformation has already likely occurred (high risk SMM). Patients with newly diagnosed high risk SMM should be offered therapy with lenalidomide or lenalidomide plus dexamethasone (Rd) for 2 years, or enrollment in clinical trials. Patients with low risk SMM should be observed without therapy every 3–4 months.