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2/20/20 SMM Risk of Myeloma
Understanding the possible risk of advancing to full multiple myeloma can be helpful for pre-myeloma patients (MGUS and SMM). The 2/20/20 SMM risk of myeloma is one such risk predictor.
The IMWG risk stratification model for smoldering multiple myeloma study linked below explains how the 2/20/20 SMM Risk of Myeloma metric was developed.
How does the 2/20/20 risk prediction model help smoldering myeloma patients?
- Risk Stratification: The model categorizes patients into different risk groups based on three key biomarkers:
- Serum M-protein level ≥ 2 g/dL.
- Bone marrow plasma cells ≥ 20%.
- Free light chain ratio ≥ 20.
Patients with one or more of these risk factors are considered to have a higher risk of progression to symptomatic myeloma.
- Informed Decision-Making: Knowing the risk category helps both patients and clinicians make more informed decisions about monitoring and treatment. High-risk patients might be monitored more closely or considered for early intervention strategies, while low-risk patients might be followed with less frequent monitoring.
- Personalized Care Plans: By understanding the risk of progression, healthcare providers can create personalized care plans tailored to the patient’s risk level. This can include the frequency of follow-up visits, imaging studies, and laboratory tests.
- Early Intervention: For high-risk patients, the model can prompt discussions about early treatment options before the disease progresses to symptomatic myeloma. This can potentially delay or prevent complications associated with advanced disease.
- Patient Education: The model provides a clear and straightforward way to communicate risk to patients, helping them understand their condition better and participate actively in their care decisions.
Unfortunately the 2/20/20 SMM risk of myeloma prediction model fails to mention two central issues relative to all pre-myeloma patients. And those issues are
According to research, those cancer patients who pre-habilitate will respond better to treatment as well as heal more quickly from treatment. Further, early stage myeloma patients respond better to treatment, and begin with a much longer prognosis that stage 2 or 3 MM patients.
If SMM patients use whatever time they have before advancing to MM to pre-habilitate, research shows that they will do better than if they did not pre-habiltate. Even if the SMM patient processes, he/she will progress to stage 1 MM.
man hand holding his nutritional supplemets, healthy lifestyle background.
Remember that oncology rarely acknowledges the benefit of therapies such as nutrition, supplementation and lifestyle changes to the management of SMM.
Have you been diagnosed with smoldering multiple myeloma? If you would like to learn more about evidence-based non-conventional therapies to reduce your risk of advancing to full MM, email me at David.PeopleBeatingCancer@gmail.com
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
International Myeloma Working Group risk stratification model for smoldering multiple myeloma (SMM)
“Recently, MM was redefined to include biomarkers predicting a high risk of progression from SMM, thus necessitating a redefinition of SMM and its risk stratification…
…we identified three independent factors predicting progression risk at 2 years:
- serum M-protein >2 g/dL (HR: 2.1),
- involved to uninvolved free light-chain ratio >20 (HR: 2.7),
- and marrow plasma cell infiltration >20% (HR: 2.4).
This translates into 3 categories with increasing 2-year progression risk:
- 6% for low risk (38%; no risk factors, HR: 1);
- 18% for intermediate risk (33%; 1 factor; HR: 3.0),
- and 44% for high risk (29%; 2–3 factors)…
Addition of cytogenetic abnormalities (t(4;14), t(14;16), +1q, and/or del13q) allowed separation into 4 groups (low risk with 0, low intermediate risk with 1, intermediate risk with 2, and high risk with ≥3 risk factors) with 6, 23, 46, and 63% risk of progression in 2 years, respectively.
The 2/20/20 risk stratification model can be easily implemented to identify high-risk SMM for clinical research and routine practice and will be widely applicable…
Other groups, in parallel, also created different models to identify SMM patients with a progression risk at 2 years of 50% using different features like positive uptake on positron emission tomography–computed tomography (PET-CT), type of M-protein, cytogenetic abnormalities, increase in serum M-protein and decrease in hemoglobin count over time, presence of Bence Jones proteinuria, or genetic signatures, among others9,10,11,12,13,14…
We studied a large cohort of SMM patients to identify factors that predicted progression to MM with the goal of developing an easy risk score to predict the 2-year progression risk. The factors identified were
- M-protein (>2 g/dL),
- BMPCs infiltration (>20%),
- and the ratio of involved versus uninvolved sFLC (>20)…
The primary objective was to develop a risk stratification model that will identify SMM patients who have high risk of progression to MM or other plasma cell disorders (50% progression risk within the first 2 years from diagnosis) based on the 2014 IMWG criteria for definition of both SMM and MM…
Time to progression (TTP) to MM or amyloidosis was the primary end point and was defined as the time elapsed between diagnosis of SMM and when the patient experienced progressive disease. All patients who did not progress at the time of last follow-up were censored in the TTP analysis. A secondary objective was to create a risk scoring tool that would allow individualized estimate of risk at various time points from diagnosis…
Survival outcomes
The median follow-up from diagnosis was 3.0 years (IQR 1.6–5.1). At the data cut-off, 815 (41%) patients had progressed to MM or a related disorder. The median TTP for the entire cohort was 6.4 years (95% CI 6.0–7.2); the 2-, 5-, and 10-year risk of progression were 22, 42, and 64%, respectively (Fig. 1)…
For convenience and simplicity, we decided to use 2 g/dL, 20%, and 20% as cut-off levels for these factors. Using these cut points, multivariable analysis identified the presence of serum M-protein >2 g/dL as an independent prognostic factor predicting high risk of progression to MM (HR: 2.07, 95% CI: 1.62–2.65), together with involved to uninvolved sFLC ratio >20 (HR: 2.66, 95% CI: 2.09–3.38) and BMPC infiltration >20% (HR: 2.39, 95% CI: 1.87–3.05)…
We then proceeded to create a risk stratification model including 1363 patients in whom all three factors were available:
- five hundred and twenty-two patients (38%) did not present any of the factors (reference group) with a risk of progression at 2 years of 6% (the low-risk group);
- 1 out of the 3 factors was identified in 445 patients (33%) with a 18% risk of progression to MM at 2 years (HR: 2.99, 95% CI: 1.97–4.54) (the intermediate-risk group);
- and the high-risk group defined by the presence of 2 or 3 risk factors included 396 patients (29%) with a 44% progression risk at 2 years (HR: 9.02, 95% CI: 6.15–13.2) (Fig. 2a).
- Of the 396 patients included in the high-risk group, 92 presented with the 3 risk factors and had a slightly higher risk of progression to MM (Fig. 2b).
We present here a simple risk stratification model that can be applied across the globe using easily available data to identify a subgroup of SMM patients with 50% progression risk at 2 years, defined by the presence of two or three factors among M-protein >2 g/dL, BMPCs infiltration >20%, or the ratio of involved to uninvolved sFLC >20…