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General questions and discussion about multiple myeloma (i.e., symptoms, lab results, news, etc.) If unsure where to post, use this discussion area.

Re: MGUS, smoldering, or active multiple myeloma?

by Multibilly on Sun Oct 23, 2016 7:31 am

In spite of some comments on this forum to the contrary, smoldering myeloma isn't the only cancer where doctors may use a watch-and-wait approach. Non-Hodgkin lymphoma (reference) and prostate cancer (reference) patients may also use this approach.

Multibilly
Name: Multibilly
Who do you know with myeloma?: Me
When were you/they diagnosed?: Smoldering, Nov, 2012

Re: MGUS, smoldering, or active multiple myeloma?

by JPC on Sun Oct 23, 2016 10:51 am

MB:

Thanks for pointing that out. Multiple myeloma being the only condition with watch and wait, as you point out, is inaccurate. However, overall, with other types of cancer, it is the opposite of the typical approach, which I do find interesting.

Regards, and good luck to you.

JPC
Name: JPC

Re: MGUS, smoldering, or active multiple myeloma?

by TerryH on Sun Oct 23, 2016 9:13 pm

First of all, it's not even clear that smoldering multiple myeloma should be called "cancer." There's an entire discussion about the subject in this thread:

"Is smoldering multiple myeloma cancer?" (Jan. 30, 2016)

which makes clear that even experts have different opinions on the subject.

Even if you want to classify it as cancer, the watch-and-wait approach "is usually recommended for patients in early stages of indolent (slow-growing) or chronic forms of blood cancers" (reference).

Here is a list of such blood cancers. It includes not just forms of lymphoma. It also includes the CLL type of leukemia (chronic lymphocytic leukemia).

I thought of this debate recently when news came out about a long-term UK study investigating different approaches for prostate cancer. For slow-growing forms of prostate cancer, the study found no difference in mortality between the watch-and-wait approach and more aggressive approaches to the disease, including radiation and surgery. At the same time, the more aggressive approaches had negative quality-of-life complications in many cases.

Results of the UK study were published in the New England Journal of Medicine. Here is a summary of the results.

Finally, JimNY does a nice job in this forum post of describing the evidence that has been published over time on the issue of actively treating smoldering multiple myeloma. Pay particular attention to what he says about the flaws in recent studies about the issue.

TerryH

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