Smoldering multiple myeloma is an intermediate stage between MGUS and myeloma and is associated with a higher risk of progression of approximately 10% year
Though the article linked below is titled “multiple myeloma” I have excerpted those statistics that are about smoldering multiple myeloma (SMM). It is important to note also that the facts/statistics linked below are based on conventional oncology’s experience. My experience and research of the world of myeloma cancer care have been very different than what is conveyed by conventional oncology.
While I believe that conventional therapies are an important weapon in the long-term care of all MM patients and survivors, experience and research have taught me tha
1) pre-myeloma patients can remain in a pre-MM state for years and
2) MM can also be managed for years.
I was diagnosed in 2/94 with a single plasmacytoma, progressed to MM and failed all forms of conventional MM treatment by 9/97. I underwent an evidence-based non-conventional therapy and reached complete remission by 4/99.
Smoldering myeloma is an intermediate stage between MGUS and myeloma is associated with a higher risk of progression of approximately 10% year.
SMM does not occur in children.
Smoldering myeloma defined as an asymptomatic process with an M protein in serum of greater than 3 g per liter or greater than 10% clonal plasma cells without organ or tissue impairment or symptoms.
Patients with smoldering multiple myeloma developed symptomatic myeloma at a rate of 10% per year for the first 5 years of follow-up, 3-4% per year for the next 5 years, and then after 10 years, the risk is 1-2% per year.
In smoldering myeloma, the M protein must be IgG or IgA subtype and the plasma cells must be clonal.
Smoldering myeloma evaluation requires followup every 3-6 months.
Smoldering multiple myeloma risk factors for progression of the disease include plasma cell mass, M protein size, the percentage of bone marrow clonal plasma cells, abnormal free light chain ratio, evolutionary pattern and pattern of magnetic resonance imaging abnormalities (Blade J).
Smoldering multiple myeloma must be distinguished from monoclonal gammopathy of unknown significance, symptomatic myeloma, and primary systemic amyloidosis.
Smoldering myeloma is now known as asymptomatic multiple myeloma and represents a progression of MGUS with a greater burden of plasma cells in the bone marrow, that is greater than 10%, and a higher annual risk of transformation to multiple myeloma, 10% for the first five years with subsequent reduction.
Patients with a free light chain ratio of <0.125 or >8 have an increased progression to symptomatic myeloma.
Smoldering will evolve into symptomatic disease in a range between 2 and 3 years.
In smoldering, the risk of progression is increased in the presence of light chain proteinuria of greater than 50 mg per 24 hours and findings of IgA monoclonal heavy chains.
The presence of asymptomatic lytic lesions implies a poor prognosis with the median time to progression for smoldering myeloma of less than one year, that explains why these lesions are excluded from patients with this diagnosis.
Time to progressive disease for a low-risk group with smoldering myeloma is 3-8 years while for high-risk patients they will evolve into symptomatic disease within one to 2 years after diagnosis.
Treatment for smoldering myeloma is observation.
Majority of patients with high-risk smoldering myeloma patients evolve into myeloma that requires treatment.
Symptomatic disease is treated immediately, whereas asymptomatic disease (SMM) requires clinical observation because early treatment does not show benefit.
When patients evolve to myeloma from monoclonal gammopathy of uncertain significance or from a smoldering phase treatment rarely results in a complete remission and when that occurs it does affect the likelihood of survival reflecting the reestablishment of a stable condition.
patients with smoldering myeloma do not require treatment, as they could be in that phase for 1-3 years.
Median time to progression to myeloma from smoldering myeloma in some series is 5-7 years, reflecting the considerable heterogeneity of the biology of the disease.