Smouldering myeloma

Smouldering myeloma, also known as smoldering myeloma, indolent myeloma or asymptomatic myeloma, is a disease which is characterised by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein (M protein).[1] In some patients, smouldering myeloma can progress to a malignant disease called multiple myeloma. Smouldering myeloma is characeterised by the lack of symptoms but a bone marrow biopsy shows presence of myeloma cells.

Diagnosis

Smouldering myeloma is characterised by:[2]

Prognosis

Smouldering myeloma with an increasingly abnormal serum free light chain (FLC) ratio is associated with a higher risk for progression to active multiple myeloma.[3]

Treatment

Treatment for multiple myeloma is focused on therapies that decrease the clonal plasma cell population and consequently decrease the signs and symptoms of disease. If the disease is completely asymptomatic (i.e. there is a paraprotein and an abnormal bone marrow population but no end-organ damage), as in smoldering myeloma, treatment is typically deferred, or restricted to clinical trials.[4]

They are generally responsive to IL-1β neutralisation.[5]

References

  1. ↑ Agarwal, A; Ghobrial, IM (1 March 2013). "Monoclonal gammopathy of undetermined significance and smoldering multiple myeloma: a review of the current understanding of epidemiology, biology, risk stratification, and management of myeloma precursor disease.". Clinical cancer research : an official journal of the American Association for Cancer Research. 19 (5): 985–94. doi:10.1158/1078-0432.ccr-12-2922. PMC 3593941Freely accessible. PMID 23224402.
  2. ↑ Rajkumar, SV; Dimopoulos, MA; Palumbo, A; Blade, J; Merlini, G; Mateos, MV; Kumar, S; Hillengass, J; Kastritis, E; Richardson, P; Landgren, O; Paiva, B; Dispenzieri, A; Weiss, B; LeLeu, X; Zweegman, S; Lonial, S; Rosinol, L; Zamagni, E; Jagannath, S; Sezer, O; Kristinsson, SY; Caers, J; Usmani, SZ; Lahuerta, JJ; Johnsen, HE; Beksac, M; Cavo, M; Goldschmidt, H; Terpos, E; Kyle, RA; Anderson, KC; Durie, BG; Miguel, JF (November 2014). "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma.". The Lancet. Oncology. 15 (12): e538–48. doi:10.1016/s1470-2045(14)70442-5. PMID 25439696.
  3. ↑ Ballew, C; Liu, K; Savage, P; Oberman, A; Smoak, C (1990). "The utility of indirect measures of obesity in racial comparisons of blood pressure. CARDIA Study Group.". Blood. 43 (8): 799–804. doi:10.1182/blood-2007-08-108357. PMID 2200851.
  4. ↑ Korde N; Kristinsson SY; Landgren O (2011). "Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM): novel biological insights and development of early treatment strategies". Blood (journal). 117 (21): 5573–5581. doi:10.1182/blood-2011-01-270140. PMC 3316455Freely accessible. PMID 21441462.
  5. ↑ Dinarello CA (2011). "Interleukin-1 in the pathogenesis and treatment of inflammatory diseases". Blood. 117 (14): 3720–32. doi:10.1182/blood-2010-07-273417. PMC 3083294Freely accessible. PMID 21304099.

Further reading

  • Barlogie B, van Rhee F, Shaughnessy JD, Epstein J, Yaccoby S, Pineda-Roman M, Hollmig K, Alsayed Y, Hoering A, Szymonifka J, Anaissie E, Petty N, Kumar NS, Srivastava G, Jenkins B, Crowley J, Zeldis JB (Oct 15, 2008). "Seven-year median time to progression with thalidomide for smoldering myeloma: partial response identifies subset requiring earlier salvage therapy for symptomatic disease.". Blood. 112 (8): 3122–5. doi:10.1182/blood-2008-06-164228. PMC 2569167Freely accessible. PMID 18669874. 
  • Pérez-Persona E, Vidriales MB, Mateo G, García-Sanz R, Mateos MV, de Coca AG, Galende J, Martín-Nuñez G, Alonso JM, de Las Heras N, Hernández JM, Martín A, López-Berges C, Orfao A, San Miguel JF (Oct 1, 2007). "New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow plasma cells.". Blood. 110 (7): 2586–92. doi:10.1182/blood-2007-05-088443. PMID 17576818. 
  • Kyle RA, Durie BG, Rajkumar SV, Landgren O, Blade J, Merlini G, Kröger N, Einsele H, Vesole DH, Dimopoulos M, San Miguel J, Avet-Loiseau H, Hajek R, Chen WM, Anderson KC, Ludwig H, Sonneveld P, Pavlovsky S, Palumbo A, Richardson PG, Barlogie B, Greipp P, Vescio R, Turesson I, Westin J, Boccadoro M (Jun 2010). "Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management.". Leukemia. 24 (6): 1121–7. doi:10.1038/leu.2010.60. PMID 20410922. 
  • Dispenzieri, A; Kumar, S (Oct 31, 2013). "Treatment for high-risk smoldering myeloma.". The New England Journal of Medicine. 369 (18): 1764. doi:10.1056/NEJMc1310911#SA3. PMID 24171529. 
  • "Treatment for High-Risk Smoldering Myeloma". New England Journal of Medicine. 369 (18): 1762–1765. 31 October 2013. doi:10.1056/NEJMc1310911. 

External links

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