Smoldering myeloma is a precursor stage of multiple myeloma. 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). Until treatment side effects become completely benign, it is critical for doctors to assess the likelihood of progression to know who will and won't progress in order to treat those who need it most.
One group that could benefit from treatment is the high-risk smoldering myeloma group. These patients are estimated to progress to active myeloma within 2 years of diagnosis. They typically have high risk myeloma genetic features or other conditions that show faster progression to active disease.
Having smoldering myeloma can be a mental challenge, waiting for the "other shoe to drop," so to speak. As smoldering myeloma patient Dana Holmes knows, it can be empowering to learn as much as you can in advance. (find the SMM FB group online and watch for a private message to confirm) There are emotional and mental benefits to understanding your disease and having a game plan.
But for many, the difference between smoldering myeloma and active myeloma can be confusing. In late 2014, the official criteria were updated for a smoldering myeloma diagnosis in Lancet Oncology. Here's a short description for those living with the uncertainty of a myeloma precursor condition.
According to Dr. Sagar Lonial of Emory University, if only one of these is present, a patient has low risk smoldering myeloma with a median to progression not reached with 10 year follow-up.
If two of these are present, a patient has intermediate risk smoldering myeloma with an average between 3-5 years to progression to symptomatic myeloma. The intermediate risk has an average time of between 3 and 5 years to progression.
If all three of these are present, a patient has high-risk smoldering myeloma with an average between 2-3 years of progression.
A new kind of smoldering multiple myeloma, termed light chain smoldering multiple myeloma, has been recently described in a study conducted at the Mayo Clinic, and the specific monoclonal protein level required for this diagnosis has also been added.
Smoldering myeloma patients should be observed and tested by their physician approximately every 3 months. Testing using blood tests, urine tests, bone marrow biopsy tests and imaging (PET-CT and MRIs) are all useful in the diagnosis of smoldering myeloma. Those who have bone lesions, osteoporosis or osteopenia may receive bisphosphonates.
The only opportunity to be treated with smoldering myeloma is to join a clinical trial. To find all smoldering clinical trials, click here:Smoldering Myeloma Clinical Trials
Historically, it was considered to be active myeloma if the CRAB features were present. These include:
In the revised 2014 criteria, three more markers are considered “myeloma defining events” (MDEs).
According to Dr. Vincent Rajkumar on the Myeloma Beacon, the presence of at least one of these markers will be considered sufficient for a diagnosis of multiple myeloma, regardless of the presence or absence of symptoms or CRAB features.
Each of these markers has been shown in two or more independent studies to be associated with an approximately 80 percent or higher risk of developing myeloma-related organ damage within two years.Stages of Multiple Myeloma
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