[Beacon Staff]

Review article - smoldering multiple myeloma

by Beacon Staff on Wed May 27, 2015 10:33 am

The full text of a useful review article about smoldering multiple myeloma is now available online, free of charge.

The article is published in the journal Blood, and it was written by Drs. Vincent Rajkumar, Ola Landgren, and Maria-Victoria Mateos. Topics covered in the article include:

• The current definition of smoldering myeloma
• Risk factors for progressing from smoldering myeloma to (symptomatic) multiple myeloma
• Whether or not smoldering myeloma should be treated

The article is available both in HTML and PDF format.

What do you feel are the most important points made in the article? Are there any surprises in it for you?

Here is the complete reference:

SV Rajkumar, O Landgren, M-V Mateos, "Smoldering multiple myeloma," Blood, May 14, 2015 (full text in HTML format, full text as PDF)

Below are two tables from the article related to high-risk smoldering myeloma that may be helpful to some readers.

RLMTable2.png (44.28 KiB) Viewed 4170 times

RLMTable3.png (24.97 KiB) Viewed 4170 times

[Multibilly]

Re: Review article - smoldering multiple myeloma

by Multibilly on Wed May 27, 2015 11:03 am

Table 2 is very surprising to me, as I am now apparently considered to be a high-risk smol­dering patient by this new definition. My personal high-risk match is a bone marrow plasma cell per­cent­age (BMPC) of 11% plus a free light chain (FLC) ratio of 20.

I thought it used to be that one had to meet 3 criteria to be considered as high-risk smoldering multiple myeloma (i.e. >10% BMPC + > 3g/dL M-spike + > 8 FLC ratio). This definition simply calls for only meeting a BMPC of > 10% and one of several different criteria.

It's also interesting that they are now using cytogenetics to assign risk level to smoldering multiple myeloma, which is new and makes sense to me.

I'm curious who else has been re-classified from low- or intermediate-risk to high-risk smoldering multiple myeloma based on these new criteria?

[skolman]

Re: Review article - smoldering multiple myeloma

by skolman on Wed May 27, 2015 1:49 pm

I guess I would be considered high risk also since I have the del(17p) and t(4;14). My bone mar­row biopsy showed 40-50% also. But I have been considered "stable" since November of 2013. Hope I remain stable. I have been taking 8 grams of curcumin daily also since November of 2013.

Now I am a little on the nervous side. I go for my blood work again next week. Should be in­ter­esting.

[SueT]

Re: Review article - smoldering multiple myeloma

by SueT on Wed May 27, 2015 2:44 pm

I'm not clear about the cytogenetic findings that indicate the risk of progression. Do I need to have all three – t(4;14), del(17p), and 1q gain – to be considered to have a high risk of progression? I only have the 1q gain, plus a couple of monosomies and trisomies.

I have remained stable since October 2013 and also take curcumin.

[Multibilly]

Re: Review article - smoldering multiple myeloma

by Multibilly on Wed May 27, 2015 4:56 pm

SueT,

It looks like from Table 2 that you only need to have ONE of those high risk mutations (in con­junc­tion with a >10% BMPC) to be considered "high risk".

From Table 2:

t(4;14) OR del(17p) OR 1q gain

But what's unclear to me is if a smoldering patient has a BMPC < 10% (but still has a sufficient M-spike to qualify as being smoldering), do these cytogenetic risk classifications in Table 3 still apply?

[FingersCrossed]

Re: Review article - smoldering multiple myeloma

by FingersCrossed on Thu May 28, 2015 9:27 am

I would be classified as high-risk by these criteria, via bone marrow close to 20% and del(17p). My FISH report indicated only a small % of del(17p) and a higher percentage of the trisomies that are considered to be better (or at least not as harmful).

[Jer610]

Re: Review article - smoldering multiple myeloma

by Jer610 on Thu May 28, 2015 4:15 pm

With respect to baseline numbers, when initially diagnosed with MGUS, would the same risks apply with the FLC and immunoparesis?

A year ago my baseline numbers were: kappa 4.2, lambda 198.88, for a ratio of 0.02 or 50.1; IgA 44, IgG 1740, IgM 41, for immunoparesis; and an M spike of 1.3 g/dL.

I go in for complete labs in 2 weeks, and a CT scan in 3 weeks prior to a meeting with my hema­tologist at the end of June.

[smarty]

Re: Review article - smoldering multiple myeloma

by smarty on Fri May 29, 2015 8:22 am

Looks like this puts me in high risk also. Plasma cell, 10 - 20%, FLC ratio 11%, MRI, diffuse patchy signal and Immunoparesis. I have not had PET scan or full body MRI. I feel well other than back pain. Hope to hear this new criteria is off.

[Dianem]

Re: Review article - smoldering multiple myeloma

by Dianem on Fri May 29, 2015 12:58 pm

Hi -

On the risks groups from Table 3, there are two types of trisomy risk:

1) Intermediate risk with trisomies without IgH translocation. and
2) Standard risk with presence of trisomy and IgH translocation.

I've had IgG MGUS for over 3 and half years and results from a bone marrow aspiration (BMA) found a trisomic (7). After reviewing the BMA data, I can't find if there is or isn't a IgH trans­loca­tion associated the trisomic. I'm assuming the cytogenetic risks would be the same for MGUS?

[jhorner]

Re: Review article - smoldering multiple myeloma

by jhorner on Sun May 31, 2015 4:29 pm

Hello,

I too would be considered high risk with this new criteria due to immunoparesis and immuno­phenotype percentage. My m-spike is stable. My FLC ratio can't be used to measure due to bi­clonal process. I too take 4 grams of curcumin daily.

Best
J