TY - JOUR
T1 - Smoldering (asymptomatic) multiple myeloma
T2 - Current diagnostic criteria, new predictors of outcome, and follow-up recommendations
AU - Bladé, Joan
AU - Dimopoulos, Meletios
AU - Rosiñol, Laura
AU - Rajkumar, S. Vincent
AU - Kyle, Robert A.
PY - 2010/2/1
Y1 - 2010/2/1
N2 - Purpose: To provide an overview on smoldering (asymptomatic) multiple myeloma (SMM) including current diagnostic criteria, predictors of progression, pattern of progression, and outcome. Design: A comprehensive review of the literature on risk factors for progression, treatment attempts to delay progression and outcome in patients with SMM. Results: The risk factors for progression of SMM include: plasma cell mass including M-protein size and percentage of bone marrow clonal plasma cells (BMPC), abnormal free light chain ratio, proportion of phenotypically abnormal BMPC, immunoparesis, evolution pattern (evolving v nonevolving), and pattern of magnetic resonance imaging abnormalities. Most patients with SMM progress with anemia and/or skeletal involvement. Immediate therapy with cytotoxic agents, such as melphalan/prednisone has not resulted in improved outcome. Patients should not be treated until progressive disease with end-organ damage occurs. Increasing anemia is the most reliable indicator of progression. Conclusion: These recently recognized predictors of outcome may be helpful for better disease monitoring and for investigation of new treatment approaches. Thus, recommendations for follow-up every to 3 to 6 months depending on the risk of progression are suggested, and clinical trials with new noncytotoxic biologically derived agents to delay progression, particularly in high-risk patients, are ongoing.
AB - Purpose: To provide an overview on smoldering (asymptomatic) multiple myeloma (SMM) including current diagnostic criteria, predictors of progression, pattern of progression, and outcome. Design: A comprehensive review of the literature on risk factors for progression, treatment attempts to delay progression and outcome in patients with SMM. Results: The risk factors for progression of SMM include: plasma cell mass including M-protein size and percentage of bone marrow clonal plasma cells (BMPC), abnormal free light chain ratio, proportion of phenotypically abnormal BMPC, immunoparesis, evolution pattern (evolving v nonevolving), and pattern of magnetic resonance imaging abnormalities. Most patients with SMM progress with anemia and/or skeletal involvement. Immediate therapy with cytotoxic agents, such as melphalan/prednisone has not resulted in improved outcome. Patients should not be treated until progressive disease with end-organ damage occurs. Increasing anemia is the most reliable indicator of progression. Conclusion: These recently recognized predictors of outcome may be helpful for better disease monitoring and for investigation of new treatment approaches. Thus, recommendations for follow-up every to 3 to 6 months depending on the risk of progression are suggested, and clinical trials with new noncytotoxic biologically derived agents to delay progression, particularly in high-risk patients, are ongoing.
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U2 - 10.1200/JCO.2009.22.2257
DO - 10.1200/JCO.2009.22.2257
M3 - Review article
C2 - 20026810
AN - SCOPUS:77449085405
SN - 0732-183X
VL - 28
SP - 690
EP - 697
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 4
ER -