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. 2024 Jan 17;14(1):9.
doi: 10.1038/s41408-024-00980-5.

Mode of progression in smoldering multiple myeloma: a study of 406 patients

Nadine H Abdallah  1 , Arjun Lakshman  1 , Shaji K Kumar  1 , Joselle Cook  1 , Moritz Binder  1 , Prashant Kapoor  1 , Angela Dispenzieri  1 , Morie A Gertz  1 , Martha Q Lacy  1 , Suzanne R Hayman  1 , Francis K Buadi  1 , David Dingli  1 , Yi Lin  1 , Taxiarchis Kourelis  1 , Rahma Warsame  1 , Leif Bergsagel  2 , S Vincent Rajkumar  3
Affiliations

Mode of progression in smoldering multiple myeloma: a study of 406 patients

Nadine H Abdallah et al. Blood Cancer J. .

Abstract

The approach to patients with high-risk smoldering multiple myeloma (SMM) varies among clinicians; while some advocate early intervention, others reserve treatment at progression to multiple myeloma (MM). We aimed to describe the myeloma-defining events (MDEs) and clinical presentations leading to MM diagnosis among SMM patients seen at our institution. We included 406 patients diagnosed with SMM between 2013-2022, seen at Mayo Clinic, Rochester, MN. The 2018 Mayo 20/2/20 criteria were used for risk stratification. Median follow-up was 3.9 years. Among high-risk patients who did not receive treatment in the SMM phase (n = 71), 51 progressed by last follow-up; the MDEs included: bone lesions (37%), anemia (35%), hypercalcemia (8%), and renal failure (6%); 24% met MM criteria based on marrow plasmacytosis (≥60%) and/or free light chain ratio (>100); 45% had clinically significant MDEs (hypercalcemia, renal insufficiency, and/or bone lesions). MM diagnosis was made based on surveillance labs/imaging(45%), testing obtained due to provider suspicion for progression (14%), bone pain (20%), and hospitalization/ED presentations due to MM complications/symptoms (4%). The presentation was undocumented in 14%. A high proportion (45%) of patients with high-risk SMM on active surveillance develop end-organ damage at progression. About a quarter of patients who progress to MM are not diagnosed based on routine interval surveillance testing.

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Conflict of interest statement

SVR reports grants from NIH, outside the submitted work. PK received research funding from Takeda Pharmaceuticals, Celgene, and Amgen. AD received research funding from Celgene, Millennium Pharmaceuticals, Pfizer, and Janssen and received a travel grant from Pfizer. MAG served as a consultant for Millennium Pharmaceuticals and received honoraria from Celgene, Millennium Pharmaceuticals, Onyx Pharmaceuticals, Novartis, GlaxoSmithKline, Prothena, Ionis Pharmaceuticals, and Amgen. MQL received research funding from Celgene. SKK served as a consultant for Celgene, Millennium Pharmaceuticals, Onyx Pharmaceuticals, Janssen, and Bristol-Myers Squibb and received research funding from Celgene, Millennium Pharmaceuticals, Novartis, Onyx Pharmaceuticals, AbbVie, Janssen, and Bristol-Myers Squibb. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1. MDEs by SMM risk group.
MDEs in patients with high-risk, intermediate- or low-risk, and unknown risk SMM. BMPCs bone marrow plasma cells, FLCs free light chains, MDE myeloma-defining event, MRI magnetic reasonance imaging, SMM smoldering multiple myeloma.
Fig. 2
Fig. 2. Presentations at progression by SMM risk group.
Presentations leading to the diagnosis of MM in patients with high-risk, intermediate- or low-risk, and unknown risk SMM. ED emergency department, MM multiple myeloma, SMM smoldering multiple myeloma.
See this image and copyright information in PMC

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References

    1. Kyle RA, Greipp PR. Smoldering multiple myeloma. N Engl J Med. 1980;302:1347–9. doi: 10.1056/NEJM198006123022405. - DOI - PubMed
    1. Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15:e538–48. doi: 10.1016/S1470-2045(14)70442-5. - DOI - PubMed
    1. Ravindran A, Bartley AC, Holton SJ, Gonsalves WI, Kapoor P, Siddiqui MA, et al. Prevalence, incidence and survival of smoldering multiple myeloma in the United States. Blood Cancer J. 2016;6:e486. doi: 10.1038/bcj.2016.100. - DOI - PMC - PubMed
    1. Thorsteinsdóttir S, Gíslason GK, Aspelund T, Rögnvaldsson S, Óskarsson JÞ, Sigurðardóttir GÁ, et al. Prevalence of smoldering multiple myeloma based on nationwide screening. Nat Med. 2023;29:467–72. doi: 10.1038/s41591-022-02183-6. - DOI - PMC - PubMed
    1. Perez-Persona E, Vidriales MB, Mateo G, Garcia-Sanz R, Mateos MV, de Coca AG, et al. 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. 2007;110:2586–92. doi: 10.1182/blood-2007-05-088443. - DOI - PubMed

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