Smoldering multiple myeloma: To treat or not to treat

Research output: Contribution to journalReview article

Abstract

Smoldering multiple myeloma (SMM) is an asymptomatic, intermediate stage positioned between the plasma cell disorders of monoclonal gammopathy of undermined significance and overt multiple myeloma (MM). Although the patients with SMM have a higher risk of progression to MM in comparison to their counterparts with monoclonal gammopathy of undermined significance, their clinical course can be highly variable. The standard of care for SMM, irrespective of the risk status, continues to be observation due to paucity of high-level evidence demonstrating survival or quality-of-life benefit with early intervention. With the expanded 2014 criteria for MM utilizing biomarkers, the subset of SMM patients with 70% to 80% risk of progression at 2 years (ultra-high risk SMM) is now categorized as active MM and treated prior to the development of end-organ damage. After exclusion of this group, patients with approximately 50% risk of progression in 2 years are now considered high-risk SMM, and the value of early treatment in this subset can be established only through clinical trials. Despite its limitations, a recent phase III trial (QuiRedex) has shown survival advantage to using lenalidomide and dexamethasone doublet over observation in high-risk SMM. In this article, we review the evolving concepts in the diagnosis, risk stratification, and management of SMM.

Original languageEnglish (US)
Pages (from-to)65-71
Number of pages7
JournalCancer Journal (United States)
Volume25
Issue number1
DOIs
StatePublished - Jan 1 2019

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Multiple Myeloma
Paraproteinemias
Observation
Survival
Risk Management
Standard of Care
Plasma Cells
Dexamethasone
Biomarkers
Quality of Life
Clinical Trials

Keywords

  • Asymptomatic myeloma
  • plasma cell disorder
  • risk stratification

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Smoldering multiple myeloma : To treat or not to treat. / Kapoor, Prashant; Rajkumar, S Vincent.

In: Cancer Journal (United States), Vol. 25, No. 1, 01.01.2019, p. 65-71.

Research output: Contribution to journalReview article

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