{Reference Type}: Journal Article
{Title}: Mode of progression in smoldering multiple myeloma: a study of 406 patients.
{Author}: Abdallah NH;Lakshman A;Kumar SK;Cook J;Binder M;Kapoor P;Dispenzieri A;Gertz MA;Lacy MQ;Hayman SR;Buadi FK;Dingli D;Lin Y;Kourelis T;Warsame R;Bergsagel L;Rajkumar SV;
{Journal}: Blood Cancer J
{Volume}: 14
{Issue}: 1
{Year}: 2024 01 17
{Factor}: 9.812
{DOI}: 10.1038/s41408-024-00980-5
{Abstract}: 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.