With regards to the New Criteria For The Diagnosis of Multiple Myeloma article:
The presence of at least one of these markers will be considered sufficient for a diagnosis of multiple myeloma, regardless of the presence or absence of symptoms or CRAB features. Each of these markers has been shown in two or more independent studies to be associated with an approximately 80 percent or higher risk of developing myeloma-related organ damage within two years."
This will obviously allow the SMM watch-and-waiters something to consider and perhaps more will start treatment based on these findings...BUT ... what about this?
From the Evolution, Intra-Clonal Heterogeneity article:
In this respect, using a combination of treatments that kills the maximum number of subclones is an important strategy. Indeed, such a strategy is relevant even if there is a single dominant clone that is not aggressive. That clone, by filling all of the space in the bone marrow, is likely to be suppressing the growth of more aggressive subclones. Using a small number of treatments targeted at just the dominant, less aggressive clone will leave the more aggressive subclones untreated and with more space to grow, leading to relapse."
So here's my question: If Ultra-HR-SMM folks start treatment with the goal of knocking out the disease before end-organ damage, does this mean we are now clearing the field for the more aggressive guys to grow and therefore relapse?
Are we starting a downward spiral before we really need to?
I'm sure no one can answer this, just thought it would be a good discussion!
