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Annual CT Scan for SMM???
What are the risks and benefits of an annual CT scan for smoldering multiple myeloma (SMM)? While the article linked below promotes this practice, how should SMM patients think about this practice?
As a long-term MM survivor, I would be the first person to advocate identifying MM as early as possible in SMM patients. An annual CT scan could identify possible bone involvement.
At the same time, SMM is pre-MM and could take years, if ever, to progress to frank MM. If your SMM progresses to full MM someday, you would be diagnosed at an early stage, aka stage 1. The average prognosis of stage 1 MM is much better/longer than the prognosis of MM stage 3, according to the ACS.
Annual CT scans could add up to a lot of cumulative radiation.
CT scanning and radiation dose
What are the risks and benefits of an annual whole-body CT scan for smoldering multiple myeloma patients?
✅ Benefits
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Early Detection of Disease Progression:
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SMM is an asymptomatic precursor to multiple myeloma. Imaging can detect early signs of bone lesions, which indicate progression to active disease.
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Early intervention can prevent complications like fractures, pain, or spinal cord compression.
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Comprehensive Assessment:
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Whole-body CT provides a detailed picture of skeletal involvement, more so than traditional X-rays.
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Can help differentiate between low-risk and high-risk SMM when combined with other clinical factors.
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Monitoring High-Risk Patients:
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For patients with high-risk SMM (e.g., ≥60% plasma cells, abnormal free light chain ratios, evolving M protein), annual imaging can provide reassurance or trigger timely treatment.
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⚠️ Risks
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Radiation Exposure:
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Whole-body CT scans deliver a significant dose of ionizing radiation (typically 10–20 mSv).
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Repeated annual scans can increase the lifetime risk of radiation-induced malignancy, especially in younger patients.
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Overdiagnosis and Anxiety:
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Detecting benign or incidental findings may lead to unnecessary biopsies, tests, and patient anxiety.
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False Positives/Negatives:
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CT may miss early bone marrow infiltration not yet causing bone destruction (better seen with MRI or PET-CT).
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Conversely, it might detect bone irregularities unrelated to myeloma.
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Cost and Accessibility:
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Whole-body CT may be expensive and not always covered by insurance for asymptomatic patients.
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May not be readily available in all centers.
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🔄 Comparison with Other Imaging Modalities
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MRI (Whole-body or Spine/Pelvis): Superior for detecting early marrow involvement; no radiation.
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PET-CT: Better for detecting active metabolic disease; useful if progression to active myeloma is suspected.
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Skeletal survey (X-rays): Less sensitive and largely outdated.
As is often the case, the decision of any procedure for either pre-MM or frank MM is up to the patient. You may feel pain in your spine, hip, shoulder, etc., which may compel you to undergo a full-body CT scan.
Then again, your bone marrow biopsy and other blood work may look fine, taking the pressure off you for now.
Email me at David.PeopleBeatingCancer@gmail.com with questions about diagnostic testing or any else about pre- or full-MM that you’d like to ask.
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Yearly Assessment of Bone Disease in Patients with Asymptomatic Multiple Myeloma Identifies Early Progression Events and Should Be the Standard Clinical Practice
Abstract
Smoldering multiple myeloma (SMM) represents an intermediate stage between monoclonal gammopathy of undetermined significance and symptomatic multiple myeloma (MM), with a significant risk of progression.
Bone disease is a key feature of MM, often marking the transition to symptomatic disease. Whole-body low-dose computed tomography (WBLDCT) is an easily accessible and highly sensitive imaging modality for detecting osteolytic lesions, providing an advantage over conventional skeletal surveys.
In our real-world cohort, we prospectively evaluated the role of WBLDCT in the early identification of bone progression in patients with SMM based on the recommendations by the International Myeloma Working Group.
A total of 113 patients were monitored with annual WBLDCT assessments; 36.3% progressed to symptomatic MM, with 9.7% progressing solely with bone lesions, highlighting the importance of early detection.
Therefore, integrating annual WBLDCT assessments into clinical practice for SMM patients is essential to facilitate treatment strategies and prevent disease-related complications. This is even more important in the upcoming era of early treatment initiation for patients with SMM at high risk for progression…
annual CT scan for SMM annual CT scan for SMM annual CT scan for SMM