Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria

• Published in: Blood cancer journal (New York) 2018-06, Vol.8 (6), p.59-10, Article 59
• Main Authors: Lakshman, Arjun, Rajkumar, S. Vincent, Buadi, Francis K., Binder, Moritz, Gertz, Morie A., Lacy, Martha Q., Dispenzieri, Angela, Dingli, David, Fonder, Amie L., Hayman, Suzanne R., Hobbs, Miriam A., Gonsalves, Wilson I., Hwa, Yi Lisa, Kapoor, Prashant, Leung, Nelson, Go, Ronald S., Lin, Yi, Kourelis, Taxiarchis V., Warsame, Rahma, Lust, John A., Russell, Stephen J., Zeldenrust, Steven R., Kyle, Robert A., Kumar, Shaji K.
• Format: Article
• Language: English
• Subjects: 38/32; 631/208/1405; 631/208/68; 631/67/1990/804; 631/67/68; 692/499; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Biomedical and Life Sciences; Biomedicine; Bone Marrow - pathology; Cancer Research; Disease Progression; Female; Health risk assessment; Hematology; Humans; In Situ Hybridization, Fluorescence; Male; Middle Aged; Multimodal Imaging; Multiple myeloma; Myeloma Proteins; Odds Ratio; Oncology; Practice Guidelines as Topic - standards; Prognosis; Risk Factors; Smoldering Multiple Myeloma - blood; Smoldering Multiple Myeloma - diagnosis; Smoldering Multiple Myeloma - mortality
• ISSN: 2044-5385; 2044-5385
• DOI: 10.1038/s41408-018-0077-4

In 2014, the International Myeloma Working Group reclassified patients with smoldering multiple myeloma (SMM) and bone marrow-plasma cell percentage (BMPC%) ≥ 60%, or serum free light chain ratio (FLCr) ≥ 100 or >1 focal lesion on magnetic resonance imaging as multiple myeloma (MM). Predictors of progression in patients currently classified as SMM are not known. We identified 421 patients with SMM, diagnosed between 2003 and 2015. The median time to progression (TTP) was 57 months (CI, 45–72). BMPC% > 20% [hazard ratio (HR): 2.28 (CI, 1.63–3.20); p   2g/dL [HR: 1.56 (CI, 1.11–2.20); p  = 0.01], and FLCr > 20 [HR: 2.13 (CI, 1.55–2.93); p   2 g/dL, and FLCr > 20 at diagnosis can be used to risk stratify patients with SMM. Patients with high-risk SMM need close follow-up and are candidates for clinical trials aiming to prevent progression.