Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria

Arjun Lakshman, S Vincent Rajkumar, Francis K. Buadi, Moritz Binder, Morie Gertz, Martha Lacy, Angela Dispenzieri, David M Dingli, Amie L. Fonder, Suzanne R. Hayman, Miriam A. Hobbs, Wilson Gonsalves, Yi Lisa Hwa, Prashant Kapoor, Nelson Leung, Ronald S. Go, Yi Lin, Taxiarchis Kourelis, Rahma Warsame, John A. LustStephen J Russell, Steven R. Zeldenrust, Robert A. Kyle, Shaji K Kumar

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

In 2014, the International Myeloma Working Group reclassified patients with smoldering multiple myeloma (SMM) and bone marrow-plasma cell percentage (BMPC%) ≥ 60%, or serum free light chain ratio (FLCr) ≥ 100 or >1 focal lesion on magnetic resonance imaging as multiple myeloma (MM). Predictors of progression in patients currently classified as SMM are not known. We identified 421 patients with SMM, diagnosed between 2003 and 2015. The median time to progression (TTP) was 57 months (CI, 45-72). BMPC% > 20% [hazard ratio (HR): 2.28 (CI, 1.63-3.20); p < 0.0001]; M-protein > 2g/dL [HR: 1.56 (CI, 1.11-2.20); p = 0.01], and FLCr > 20 [HR: 2.13 (CI, 1.55-2.93); p < 0.0001] independently predicted shorter TTP in multivariate analysis. Age and immunoparesis were not significant. We stratified patients into three groups: low risk (none of the three risk factors; n = 143); intermediate risk (one of the three risk factors; n = 121); and high risk (≥2 of the three risk factors; n = 153). The median TTP for low-, intermediate-, and high-risk groups were 110, 68, and 29 months, respectively (p < 0.0001). BMPC% > 20%, M-protein > 2 g/dL, and FLCr > 20 at diagnosis can be used to risk stratify patients with SMM. Patients with high-risk SMM need close follow-up and are candidates for clinical trials aiming to prevent progression.

Original languageEnglish (US)
Article number59
JournalBlood Cancer Journal
Volume8
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Multiple Myeloma
Plasma Cells
Light
Bone Marrow Cells
Magnetic Resonance Imaging
Clinical Trials
Serum
Proteins

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria. / Lakshman, Arjun; Rajkumar, S Vincent; Buadi, Francis K.; Binder, Moritz; Gertz, Morie; Lacy, Martha; Dispenzieri, Angela; Dingli, David M; Fonder, Amie L.; Hayman, Suzanne R.; Hobbs, Miriam A.; Gonsalves, Wilson; Hwa, Yi Lisa; Kapoor, Prashant; Leung, Nelson; Go, Ronald S.; Lin, Yi; Kourelis, Taxiarchis; Warsame, Rahma; Lust, John A.; Russell, Stephen J; Zeldenrust, Steven R.; Kyle, Robert A.; Kumar, Shaji K.

In: Blood Cancer Journal, Vol. 8, No. 6, 59, 01.06.2018.

Research output: Contribution to journalArticle

Lakshman, Arjun ; Rajkumar, S Vincent ; Buadi, Francis K. ; Binder, Moritz ; Gertz, Morie ; Lacy, Martha ; Dispenzieri, Angela ; Dingli, David M ; Fonder, Amie L. ; Hayman, Suzanne R. ; Hobbs, Miriam A. ; Gonsalves, Wilson ; Hwa, Yi Lisa ; Kapoor, Prashant ; Leung, Nelson ; Go, Ronald S. ; Lin, Yi ; Kourelis, Taxiarchis ; Warsame, Rahma ; Lust, John A. ; Russell, Stephen J ; Zeldenrust, Steven R. ; Kyle, Robert A. ; Kumar, Shaji K. / Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria. In: Blood Cancer Journal. 2018 ; Vol. 8, No. 6.
@article{452ac758ed304c008d3ae836c954e756,
title = "Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria",
abstract = "In 2014, the International Myeloma Working Group reclassified patients with smoldering multiple myeloma (SMM) and bone marrow-plasma cell percentage (BMPC{\%}) ≥ 60{\%}, or serum free light chain ratio (FLCr) ≥ 100 or >1 focal lesion on magnetic resonance imaging as multiple myeloma (MM). Predictors of progression in patients currently classified as SMM are not known. We identified 421 patients with SMM, diagnosed between 2003 and 2015. The median time to progression (TTP) was 57 months (CI, 45-72). BMPC{\%} > 20{\%} [hazard ratio (HR): 2.28 (CI, 1.63-3.20); p < 0.0001]; M-protein > 2g/dL [HR: 1.56 (CI, 1.11-2.20); p = 0.01], and FLCr > 20 [HR: 2.13 (CI, 1.55-2.93); p < 0.0001] independently predicted shorter TTP in multivariate analysis. Age and immunoparesis were not significant. We stratified patients into three groups: low risk (none of the three risk factors; n = 143); intermediate risk (one of the three risk factors; n = 121); and high risk (≥2 of the three risk factors; n = 153). The median TTP for low-, intermediate-, and high-risk groups were 110, 68, and 29 months, respectively (p < 0.0001). BMPC{\%} > 20{\%}, M-protein > 2 g/dL, and FLCr > 20 at diagnosis can be used to risk stratify patients with SMM. Patients with high-risk SMM need close follow-up and are candidates for clinical trials aiming to prevent progression.",
author = "Arjun Lakshman and Rajkumar, {S Vincent} and Buadi, {Francis K.} and Moritz Binder and Morie Gertz and Martha Lacy and Angela Dispenzieri and Dingli, {David M} and Fonder, {Amie L.} and Hayman, {Suzanne R.} and Hobbs, {Miriam A.} and Wilson Gonsalves and Hwa, {Yi Lisa} and Prashant Kapoor and Nelson Leung and Go, {Ronald S.} and Yi Lin and Taxiarchis Kourelis and Rahma Warsame and Lust, {John A.} and Russell, {Stephen J} and Zeldenrust, {Steven R.} and Kyle, {Robert A.} and Kumar, {Shaji K}",
year = "2018",
month = "6",
day = "1",
doi = "10.1038/s41408-018-0077-4",
language = "English (US)",
volume = "8",
journal = "Blood Cancer Journal",
issn = "2044-5385",
publisher = "Nature Publishing Group",
number = "6",

}

TY - JOUR

T1 - Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria

AU - Lakshman, Arjun

AU - Rajkumar, S Vincent

AU - Buadi, Francis K.

AU - Binder, Moritz

AU - Gertz, Morie

AU - Lacy, Martha

AU - Dispenzieri, Angela

AU - Dingli, David M

AU - Fonder, Amie L.

AU - Hayman, Suzanne R.

AU - Hobbs, Miriam A.

AU - Gonsalves, Wilson

AU - Hwa, Yi Lisa

AU - Kapoor, Prashant

AU - Leung, Nelson

AU - Go, Ronald S.

AU - Lin, Yi

AU - Kourelis, Taxiarchis

AU - Warsame, Rahma

AU - Lust, John A.

AU - Russell, Stephen J

AU - Zeldenrust, Steven R.

AU - Kyle, Robert A.

AU - Kumar, Shaji K

PY - 2018/6/1

Y1 - 2018/6/1

N2 - In 2014, the International Myeloma Working Group reclassified patients with smoldering multiple myeloma (SMM) and bone marrow-plasma cell percentage (BMPC%) ≥ 60%, or serum free light chain ratio (FLCr) ≥ 100 or >1 focal lesion on magnetic resonance imaging as multiple myeloma (MM). Predictors of progression in patients currently classified as SMM are not known. We identified 421 patients with SMM, diagnosed between 2003 and 2015. The median time to progression (TTP) was 57 months (CI, 45-72). BMPC% > 20% [hazard ratio (HR): 2.28 (CI, 1.63-3.20); p < 0.0001]; M-protein > 2g/dL [HR: 1.56 (CI, 1.11-2.20); p = 0.01], and FLCr > 20 [HR: 2.13 (CI, 1.55-2.93); p < 0.0001] independently predicted shorter TTP in multivariate analysis. Age and immunoparesis were not significant. We stratified patients into three groups: low risk (none of the three risk factors; n = 143); intermediate risk (one of the three risk factors; n = 121); and high risk (≥2 of the three risk factors; n = 153). The median TTP for low-, intermediate-, and high-risk groups were 110, 68, and 29 months, respectively (p < 0.0001). BMPC% > 20%, M-protein > 2 g/dL, and FLCr > 20 at diagnosis can be used to risk stratify patients with SMM. Patients with high-risk SMM need close follow-up and are candidates for clinical trials aiming to prevent progression.

AB - In 2014, the International Myeloma Working Group reclassified patients with smoldering multiple myeloma (SMM) and bone marrow-plasma cell percentage (BMPC%) ≥ 60%, or serum free light chain ratio (FLCr) ≥ 100 or >1 focal lesion on magnetic resonance imaging as multiple myeloma (MM). Predictors of progression in patients currently classified as SMM are not known. We identified 421 patients with SMM, diagnosed between 2003 and 2015. The median time to progression (TTP) was 57 months (CI, 45-72). BMPC% > 20% [hazard ratio (HR): 2.28 (CI, 1.63-3.20); p < 0.0001]; M-protein > 2g/dL [HR: 1.56 (CI, 1.11-2.20); p = 0.01], and FLCr > 20 [HR: 2.13 (CI, 1.55-2.93); p < 0.0001] independently predicted shorter TTP in multivariate analysis. Age and immunoparesis were not significant. We stratified patients into three groups: low risk (none of the three risk factors; n = 143); intermediate risk (one of the three risk factors; n = 121); and high risk (≥2 of the three risk factors; n = 153). The median TTP for low-, intermediate-, and high-risk groups were 110, 68, and 29 months, respectively (p < 0.0001). BMPC% > 20%, M-protein > 2 g/dL, and FLCr > 20 at diagnosis can be used to risk stratify patients with SMM. Patients with high-risk SMM need close follow-up and are candidates for clinical trials aiming to prevent progression.

UR - http://www.scopus.com/inward/record.url?scp=85048364108&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048364108&partnerID=8YFLogxK

U2 - 10.1038/s41408-018-0077-4

DO - 10.1038/s41408-018-0077-4

M3 - Article

C2 - 29895887

AN - SCOPUS:85048364108

VL - 8

JO - Blood Cancer Journal

JF - Blood Cancer Journal

SN - 2044-5385

IS - 6

M1 - 59

ER -