Hello,
I hope you are all doing fine.
I have read many articles about smoldering myeloma. Some of them refer to it as a precursor of multiple myeloma, others as the early stage of multiple myeloma and others as a condition like MGUS but with more clones of antibodies.
So my question is: Is smoldering myeloma a cancer or a malignant condition?
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Re: Smoldering myeloma - is it a malignant condition?
Dear ana87,
As I understand, the standard was to wait until patients with smoldering myeloma experienced some of the "CRAB" symptoms. But the general practice seems to be changing towards a more proactive approach. See, for example,
S Vincent Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
Smoldering myeloma is probably not in itself a malignant condition, but the risk that it will develop into multiple myeloma with at least some of the CRAB symptoms is very high.
Until recently, treatment was only given as part of clinical trials, but depending on blood tests, bone marrow biopsy, and urine tests, many who would previously have had to wait and see now will probably be offered treatment.
You could also say that the threshold for the multiple myeloma diagnosis has been lowered, and that a lot of patients who was defined as smoldering are now defined as multiple myeloma.
But different hospitals / countries may have different policies, or may be slower / faster when it comes to adopting new procedures.
I am a lay person, and should anyone have a better or more correct answer, please let me know.
As I understand, the standard was to wait until patients with smoldering myeloma experienced some of the "CRAB" symptoms. But the general practice seems to be changing towards a more proactive approach. See, for example,
S Vincent Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
Smoldering myeloma is probably not in itself a malignant condition, but the risk that it will develop into multiple myeloma with at least some of the CRAB symptoms is very high.
Until recently, treatment was only given as part of clinical trials, but depending on blood tests, bone marrow biopsy, and urine tests, many who would previously have had to wait and see now will probably be offered treatment.
You could also say that the threshold for the multiple myeloma diagnosis has been lowered, and that a lot of patients who was defined as smoldering are now defined as multiple myeloma.
But different hospitals / countries may have different policies, or may be slower / faster when it comes to adopting new procedures.
I am a lay person, and should anyone have a better or more correct answer, please let me know.
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Lev - Name: Lev
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 57
Re: Smoldering myeloma - is it a malignant condition?
Hello,
I was hoping you would get additional responses to this question because it is indeed a curious question. I believe it is a malignant condition because it is either slow growing myeloma, which isn't just a plasma cell dyscrasia but a plasma cell malignancy, OR it is a plasmacytoma, which is a malignant plasma cell tumor.
I believe the entire premise of smoldering myeloma is to wait until it interferes with quality of life to treat. Even with the new IMWG criteria for treatment, organ involvement is imminent.
Now that 10-15% of SMM is considered multiple myeloma, I'm curious to see how the remaining people with smoldering are classified into high risk and low risk and what that means for follow up.
Best
J
I was hoping you would get additional responses to this question because it is indeed a curious question. I believe it is a malignant condition because it is either slow growing myeloma, which isn't just a plasma cell dyscrasia but a plasma cell malignancy, OR it is a plasmacytoma, which is a malignant plasma cell tumor.
I believe the entire premise of smoldering myeloma is to wait until it interferes with quality of life to treat. Even with the new IMWG criteria for treatment, organ involvement is imminent.
Now that 10-15% of SMM is considered multiple myeloma, I'm curious to see how the remaining people with smoldering are classified into high risk and low risk and what that means for follow up.
Best
J
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jhorner - Name: Magpie
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2013
- Age at diagnosis: 49
Re: Smoldering myeloma - is it a malignant condition?
This is a common question – and a confusing one, because it relies on definitions used. MGUS, smoldering multiple myeloma and symptomatic myeloma are all clonal blood diseases. Meaning: There is an abnormal, immortalized clone of plasma cells that persists and accumulates in the bone marrow (or other places). The definition of 'malignant' is a nebulous one. However, in the setting of cancer, it is often used to mean 'nature is to spread or advance', or 'dangerous', or something of the like. As such, smoldering myeloma is often not 'malignant', because, by definition, it is not injurious or dangerous.
I think, though, that this discussion really misses the point. The spectrum of smoldering multiple myeloma to multiple myeloma is one that we struggle to define in absolute terms, where the truth is far from absolute. The cells under the microscope can look the same, the cytogenetics / FISH testing cannot tell them apart. It comes down to organ damage (and, with new definition of multiple myeloma, to high volume disease very prone to cause near term damage).
It is best in my opinion is to understand what SMM is and not too try to hard to place it in confusing categories. If desired, you could refer to it as malignant, or, if desired, it can be called pre-malignant.
Hope this helps.
I think, though, that this discussion really misses the point. The spectrum of smoldering multiple myeloma to multiple myeloma is one that we struggle to define in absolute terms, where the truth is far from absolute. The cells under the microscope can look the same, the cytogenetics / FISH testing cannot tell them apart. It comes down to organ damage (and, with new definition of multiple myeloma, to high volume disease very prone to cause near term damage).
It is best in my opinion is to understand what SMM is and not too try to hard to place it in confusing categories. If desired, you could refer to it as malignant, or, if desired, it can be called pre-malignant.
Hope this helps.
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Dr. James Hoffman - Name: James E. Hoffman, M.D.
Beacon Medical Advisor
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