March 2016: I just changed the title of this post, “smoldering for 14 years” to “smoldering for 18 years,” based on TAB’s most recent comment. Congratulations, TAB! I am now in my 11th year since my SMM diagnosis (17 years if you add my MGUS years), and it feels soooo good, doesn’t it? Anyway, thanks for the update…You are such an inspiration for all of us! 
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Smoldering Multiple Myeloma Diagnosis 4,14 Translocation-
“Conclusions: Thus, this study (by far the largest so far reported) shows that VD as induction before intensification is able to improve the prognosis of patients with t(4,14), but not of those with del(17p).”
Dear David- My 41-year old son just received a diagnosis of smoldering multiple myeloma with a 4,14 translocation. He had COVID-19 in March, and when he attempted to donate plasma, they referred him to a blood oncologist. Today we received the results of the bone marrow biopsy…
My son is in good health, athletic, energetic. Not anemic. No bone pain or nerve pain. I do not have his BMB results in writing. I took notes as the doctor was explaining the results yesterday. I will get the results to you.
She said there are 20% plasma cells in his bone marrow. His Kappa Lambda ratio is 7 or that could be the free light chain number (sorry, I need to learn what the terminology is) His FISH Testing Translocation was 4,14 which I think indicates some type of risk for progression. She told us that she would expect him to go from smoldering to active in less than 2 years. He is scheduled for a Pet Scan in a week. He has not done a 24-hour urine analysis yet. She has recommended that we seek a second opinion at Sloan or Mount Sinai in NY.
My father is in remission from MM. He was diagnosed at 79. My father’s doctor is at Mount Sinai. Any information you can provide is appreciated. Linda
Hi Linda-
Several things. The MM Cancer Coaching Program will be of use to your son. Secondly, I encourage your son to establish a relationship with a MM specialist. Research on the issue of the benefit of MM specialists is clear. MM is a rare blood cancer (2% of all cancer diagnoses, 10% of all blood cancer diagnoses annually in the US).
I will need to study his diagnostic results- his freelight chain assay, immunoglobulins (IgG, IgA, IgM), etc. If your son’s FISH analysis indicates a 4,14 translocation then yes, his prognosis is negatively affected. I encourage you to read both blog posts linked below.
At 41, your son is young for a diagnosis of SMM. At this point I believe your son’s focus should be to pursue non-toxic therapies:
- anti-angiogenic nutrition,
- supplementation,
- exercise,
etc. in an effort to keep him pre-MM aka SMM. Margaret of Margaret’s Corner has been living with SMM for more than 15 years I believe.
Your son’s first step is to read the MM CC guides, watch the MM CC videos. If you can forward his diagnostic info to me I will prepare an agenda for our talk.
Let me know if you have any questions.
Hang in there,
David Emerson
MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer
Recommended Reading:
Margaret’s Corner-
“SMOLDERING FOR 18 YEARS: TAB’s story…
Multiple Myeloma- PreHabilitation Pre Induction of RVd
“As for your question “What input/suggestions do you have prior to chemo and during for 6 to 8 cycles do you have to improve efficacy and minimize collateral damage/ side effects?”
Studies show that you will respond better, on average, if you “pre-habilitate.” Pre-habilitation is like you are “getting in shape” for a sport or an event. Nothing extreme but if you could exercise a bit daily (a brisk walk, for example), stop tobacco, little or no alcohol, include angiogenic-inhibiting foods (see in your nutrition guide), and supplement, again with anti-angiogenic supplements…”
Multiple Myeloma Diagnosis t(4:14) No ASCT-
Use of bortezomib to overcome the poor prognosis of t(4:14), but not del(17p), in young patients with newly diagnosed multiple myeloma.
“A translocation t(4:14) was observed in 106 of these 507 patients treated with VD, whereas del(17p) was found in 60 patients.
Of note, 10 patients presented both the t(4;14) and the del(17p). The median PFS was 28 and 35 months, in patients with or without the t(4;14), respectively (p<0.02). At 3 years, 73% of the patients with t(4;14) were still alive, as compared to 89% of the patients lacking the translocation (p=0.002).
For comparison, the OS results were respectively 48% (patients with t(4;14)) and 73% (patients lacking the translocation) in patients treated with a VAD induction within the same period.
Thus, it seems that VD is able to significantly overcome the poor prognosis of t(4;14).
We also looked at the prognostic value of del(17p) in this series of patients treated with VD. In contrast to the t(4;14) situation, VD was enable to rescue patients with del(17p) (same PFS and OS for patients treated with VD than for those treated with a VAD induction).
“Conclusions: Thus, this study (by far the largest so far reported) shows that VD as induction before intensification is able to improve the prognosis of patients with t(4:14), but not of those with del(17p).”
Familial or Genetic Predisposition to Multiple Myeloma?
“Genetic predisposition for multiple myeloma
“Multiple myeloma (MM) is the second most common blood malignancy. Epidemiological family studies going back to the 1920s have provided evidence for familial aggregation, suggesting a subset of cases have an inherited genetic background.
Recently, studies aimed at explaining this phenomenon have begun to provide direct evidence for genetic predisposition to MM. Genome-wide association studies have identified common risk alleles at 24 independent loci.
Sequencing studies of familial cases and kindreds have begun to identify promising candidate genes where variants with strong effects on MM risk might reside…”