Researchers Can Better Predict Smoldering Myeloma Patients Who Are Likely to Progress to Active Myeloma

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Some smoldering myeloma patients could be at ultra-high risk of developing myeloma within a 2-year window. If hemoglobin is reduced and the monoclonal-protein (M-protein) is increasing, patients may be at risk. These findings were reported at the recent ASCO 2016 conference, the largest oncology conference in the world.

In the study, if hemoglobin declined at a rate of 0.5 g/dL a year at the same time there was a 10% or greater rise in M-protein and other parameters, there was an 80% chance this individual with smoldering multiple myeloma would be diagnosed with the full-blown disease within 24 months, said Praful Ravi, MBBCh, of the Mayo Clinic, in Rochester, Minn, and colleagues.

Also, if patients exhibited those two risk factors as well as an increase in clonal bone marrow plasma cells, then the risk of progression to multiple myeloma within 2 years was greater that 90%, Ravi added. But Ravi cautioned that more work is needed before physicians can act on his group’s findings.

For the study, the group identified patients diagnosed with smoldering multiple myeloma who were treated at Mayo from 1973 to 2014. Patients who received myeloma-specific therapy before progression or without adequate follow-up to permit study of evolving changes in biomarkers were excluded. They defined the increase as a growth in the M-protein levels of 10% or more within 6 months of diagnosis and/or a 25% or greater increase in M-protein and/or involved immunoglobulin within the first 12 months.

About 14% of newly diagnosed multiple myeloma patients have smoldering disease. The risk of progression to multiple myeloma is 10% per year for the first 5 years, and then 3% per year for the next 3 years, and then 1% per year thereafter.

“The work in smoldering multiple myeloma is in evolution,” said Sagar Lonial, MD, of the Winship Cancer Center at Emory University in Atlanta. “There has been a lot of talk about intervening early in the smoldering myeloma patient population, and there have been some very small pilot studies that have shown very encouraging data by treating those patients early.”

“The challenge is that we really don’t know what the long-term outcome is,” explained Lonial, who was not involved in the study. “It is not a surprise to me that if we treat a newly diagnosed myeloma patients with that regimen, you are going to get great responses. But this is a long game; it is not a short game.”

To read the full article, visit MedPage today here.

To find all clinical trials for smoldering myeloma, click here:

Smoldering Myeloma Clinical Trials

To find all clinical trials for high-risk smoldering myeloma, click here:

High-Risk Smoldering Myeloma Clinical Trials

 

 

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Lizzy Smith was diagnosed with myeloma in 2012 at age 44. Within days, she left her job, ended her marriage, moved, and entered treatment. "To the extent I'm able, I want to prove that despite life's biggest challenges, it is possible to survive and come out stronger than ever," she says.

2 Comments

  1. I am very puzzled by these statistics as if I’m understanding them right, a person ONLY has a 10% or LESS chance of progressing to MM?? My friend’s mspike has always only gone as high as 1.7, goes down to .3 with 5 months treatment of Rev/vel, then he goes off for 5 months and it goes back up to 1.7 but has never been above that and no CRAB sypmtoms. He was diagnosed with MgUS in 2013 and no treatment till 2014. His IGA is high. Is he smoldering or MM??

    • Here’s what Dr. Robert Kyle told me (he created the terms MGUS and smoldering myeloma). “MGUS progresses at a rate of 1% per year to multiple myeloma, amyloidosis or Waldenstrom’s Macroglobulinemia. This continues without significant change for 40 years in our long-term follow-up. Smoldering multiple myeloma progresses at a rate of 10% per year for the first 5 years and then decreases to a rate similar to MGUS.” I would ask your friend’s doctor to make the determination if he has active myeloma or not. If he is not being seen by a myeloma specialist, I highly recommend him finding one for a consult.

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