TY - JOUR
T1 - Smoldering multiple myeloma
T2 - To treat or not to treat
AU - Kapoor, Prashant
AU - Rajkumar, S. Vincent
N1 - Funding Information:
Aggressive approaches are beginning to get evaluated with the intent of achieving a minimal residual disease (MRD) negative state and potentially cure. A recent, small pilot study at the National Institutes of Health Clinical Center enrolled 12 high-risk SMM as defined by the Mayo Clinic or the Programa para el Estudio de la Terapéutica en Hemopatía Maligna (PETHEMA) criteria (Table 1)60. Patients received eight 28-day cycles of a second-generation proteasome inhibitor carfilzomib in combination with lenalidomide and dexamethasone (KRD) followed by 24 cycles of lenalidomide extended dosing in those who had achieved at least stable disease. Although the median follow-up was short at approximately 16 months, all 12 patients had achieved at least a near CR rate, with an MRD negativity rate of 92% by multiparametric flow cytometry and 75% by next-generation sequencing.61 A subset of study population comprised patients with newly diagnosed MM who were not able to achieve as deep responses (CR, 94% with SMM vs. 64%) as observed among patients with SMM.
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
KW - Asymptomatic myeloma
KW - plasma cell disorder
KW - risk stratification
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UR - http://www.scopus.com/inward/citedby.url?scp=85060793342&partnerID=8YFLogxK
U2 - 10.1097/PPO.0000000000000350
DO - 10.1097/PPO.0000000000000350
M3 - Review article
C2 - 30694862
AN - SCOPUS:85060793342
SN - 1528-9117
VL - 25
SP - 65
EP - 71
JO - Cancer Journal (United States)
JF - Cancer Journal (United States)
IS - 1
ER -