%0 Journal Article
%T Mode of progression in smoldering multiple myeloma: a study of 406 patients.
%A Abdallah NH
%A Lakshman A
%A Kumar SK
%A Cook J
%A Binder M
%A Kapoor P
%A Dispenzieri A
%A Gertz MA
%A Lacy MQ
%A Hayman SR
%A Buadi FK
%A Dingli D
%A Lin Y
%A Kourelis T
%A Warsame R
%A Bergsagel L
%A Rajkumar SV
%J Blood Cancer J
%V 14
%N 1
%D 2024 01 17
%M 38228628
%F 9.812
%R 10.1038/s41408-024-00980-5
%X The approach to patients with high-risk smoldering multiple myeloma (SMM) varies among clinicians; while some advocate early intervention, others reserve treatment at progression to multiple myeloma (MM). We aimed to describe the myeloma-defining events (MDEs) and clinical presentations leading to MM diagnosis among SMM patients seen at our institution. We included 406 patients diagnosed with SMM between 2013-2022, seen at Mayo Clinic, Rochester, MN. The 2018 Mayo 20/2/20 criteria were used for risk stratification. Median follow-up was 3.9 years. Among high-risk patients who did not receive treatment in the SMM phase (n = 71), 51 progressed by last follow-up; the MDEs included: bone lesions (37%), anemia (35%), hypercalcemia (8%), and renal failure (6%); 24% met MM criteria based on marrow plasmacytosis (≥60%) and/or free light chain ratio (>100); 45% had clinically significant MDEs (hypercalcemia, renal insufficiency, and/or bone lesions). MM diagnosis was made based on surveillance labs/imaging(45%), testing obtained due to provider suspicion for progression (14%), bone pain (20%), and hospitalization/ED presentations due to MM complications/symptoms (4%). The presentation was undocumented in 14%. A high proportion (45%) of patients with high-risk SMM on active surveillance develop end-organ damage at progression. About a quarter of patients who progress to MM are not diagnosed based on routine interval surveillance testing.