A research review found that for patients with smoldering, or asymptomatic, multiple myeloma, beginning treatment immediately after diagnosis did not increase life span as compared to holding off treatment until cancer symptoms appeared. The analysis also found that early treatment had no impact on response to treatment, but it did delay progression of the disease.

The results of the article, which was published in the journal Cancer Treatment Review, confirm that people with smoldering multiple myeloma may be able to hold off treatment until a later stage in their myeloma.

“The standard of care for patients with smoldering multiple myeloma remains observation until additional randomized trials are completed and show a real benefit,” said Dr. S. Vincent Rajkumar of the Mayo Clinic. Dr. Rajkumar was not one of the study investigators. “The rationale for continued observation is that we do not know if early therapy prolongs survival. However, early therapy has clear risks of toxicity.”

The researchers analyzed results from Phase 3 trials comparing early and late cancer treatment. The scientists found three trials on multiple myeloma, which were published in 1993, 1994, and 2000. In all three studies, patients received non-aggressive treatment with melphalan (Alkeran) and prednisone.

The three trials included a total of 262 people with smoldering multiple myeloma who were at high risk of progressing to multiple myeloma. In each trial, about half of the study participants received treatment as soon as they were diagnosed, and half of the study participants received treatment when they began showing myeloma symptoms.

According to Dr. Rajkumar, treatment should be started as soon as there is any evidence of kidney dysfunction, anemia (low red blood cell counts), bone lesions, or high calcium levels in the blood that are caused by the myeloma.

The researchers were not able to find exactly how many days treatment can be delayed without affecting survival times. They also cautioned that some effects of cancer, such as kidney failure, are life-threatening and need to be treated right away.

These results reinforce that there is a “window of opportunity” after an early smoldering multiple myeloma diagnosis. Patients may be able to choose to wait to start chemotherapy after an important event, like a wedding or a graduation, or after they finish a work task or manage insurance tasks. Younger patients who wish to have children may be able to set aside eggs or sperm.

The research review found similar results for chronic lymphocytic leukemia, lung cancer, and follicular lymphoma. However, it found longer survival times with early treatment for prostate cancer.

“More such studies on a larger scale are needed,” said Dr. Rajkumar. “Such a study will open later in the year in the United States. It is an Eastern Cooperative Oncology Group trial of Revlimid (lenalidomide) versus observation for high-risk smoldering multiple myeloma. Until studies show survival benefits, the standard of care remains observation.”

For more information, please see the article in the journal Cancer Treatment Reviews.