Yearly Assessment of Bone Disease in Patients with Asymptomatic Multiple Myeloma Identifies Early Progression Events and Should Be the Standard Clinical Practice

Abstract

Smoldering multiple myeloma (SMM) represents an intermediate stage between monoclonal gammopathy of undetermined significance and symptomatic multiple myeloma (MM), with a significant risk of progression. Bone disease is a key feature of MM, often marking the transition to symptomatic disease. Whole-body low-dose computed tomography (WBLDCT) is an easily accessible and highly sensitive imaging modality for detecting osteolytic lesions, providing an advantage over conventional skeletal surveys. In our real-world cohort, we prospectively evaluated the role of WBLDCT in the early identification of bone progression in patients with SMM based on the recommendations by the International Myeloma Working Group. A total of 113 patients were monitored with annual WBLDCT assessments; 36.3% progressed to symptomatic MM, with 9.7% progressing solely with bone lesions, highlighting the importance of early detection. Therefore, integrating annual WBLDCT assessments into clinical practice for SMM patients is essential to facilitate treatment strategies and prevent disease-related complications. This is even more important in the upcoming era of early treatment initiation for patients with SMM at high risk for progression.

Keywords: bone; early diagnosis; multiple myeloma; smoldering multiple myeloma; treatment; whole-body low-dose computed tomography.

Figure 1

Kaplan–Meier curves depicting (A) the time to progression (TTP) from smoldering to symptomatic MM for bone-only progressors and other progressors, and (B) the progression-free survival (PFS) among patients with evolution to symptomatic multiple myeloma (n = 41) for bone-only progressors and other progressors.