Smouldering myeloma
| Smouldering myeloma | |
|---|---|
| Other names | Smoldering myeloma, Smoldering multiple myeloma, Indolent myeloma or Asymptomatic myeloma |
| Specialty | Hematology/oncology |
Smouldering myeloma is a disease classified as intermediate in a spectrum of step-wise progressive diseases termed
Diagnosis
Smouldering myeloma is characterised by:[4]
- Serum paraprotein >30 g/L or urinary monoclonal protein ≥500 mg per 24 h AND/OR
- Clonal plasma cells >10% and <60% on bone marrow biopsy AND
- No evidence of end organ damage that can be attributed to plasma cell disorder AND
- No myeloma-defining event (>60% plasma cells in bone marrow OR Involved/Uninvolved light chain ratio>100)
Treatment
Treatment for multiple myeloma is focused on therapies that decrease the clonal plasma cell population and consequently decrease the signs and symptoms of disease. If the disease is completely asymptomatic (i.e. there is a paraprotein and an abnormal bone marrow population but no end-organ damage), as in smouldering myeloma, treatment is typically deferred, or restricted to clinical trials.[5]
They are generally responsive to
Prognosis
Smouldering myeloma with an increasingly abnormal serum free light chain (FLC) ratio is associated with a higher risk for progression to active multiple myeloma.[7]
References
Further reading
- Barlogie B, van Rhee F, Shaughnessy JD, Epstein J, Yaccoby S, Pineda-Roman M, Hollmig K, Alsayed Y, Hoering A, Szymonifka J, Anaissie E, Petty N, Kumar NS, Srivastava G, Jenkins B, Crowley J, Zeldis JB (Oct 15, 2008). "Seven-year median time to progression with thalidomide for smoldering myeloma: partial response identifies subset requiring earlier salvage therapy for symptomatic disease". Blood. 112 (8): 3122–5. PMID 18669874.
- Pérez-Persona E, Vidriales MB, Mateo G, García-Sanz R, Mateos MV, de Coca AG, Galende J, Martín-Nuñez G, Alonso JM, de Las Heras N, Hernández JM, Martín A, López-Berges C, Orfao A, San Miguel JF (Oct 1, 2007). "New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow plasma cells". Blood. 110 (7): 2586–92. PMID 17576818.
- Kyle RA, Durie BG, Rajkumar SV, Landgren O, Blade J, Merlini G, Kröger N, Einsele H, Vesole DH, Dimopoulos M, San Miguel J, Avet-Loiseau H, Hajek R, Chen WM, Anderson KC, Ludwig H, Sonneveld P, Pavlovsky S, Palumbo A, Richardson PG, Barlogie B, Greipp P, Vescio R, Turesson I, Westin J, Boccadoro M (Jun 2010). "Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management". Leukemia. 24 (6): 1121–7. PMID 20410922.
- Dispenzieri, A; Kumar, S (Oct 31, 2013). "Treatment for high-risk smoldering myeloma". The New England Journal of Medicine. 369 (18): 1764. PMID 24171529.
- Dispenzieri A, Kumar S (31 October 2013). "Treatment for High-Risk Smoldering Myeloma". New England Journal of Medicine. 369 (18): 1762–1765. PMID 24171529.