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    Asymptomatic Myeloma Prognosis

    Predicts risk of progression of asymptomatic (smoldering) multiple myeloma to active myeloma or amyloidosis.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Newly diagnosed multiple myeloma (MM) patients meeting International Myeloma Working Group criteria for smoldering or asymptomatic MM (see Pearls/Pitfalls for criteria).

    The Asymptomatic Myeloma Prognosis calculator classifies smoldering multiple myeloma (MM) patients into 3 prognostic groups, with differing risks of progression to active MM or amyloidosis.

    The criteria developed by the International Myeloma Working Group for diagnosis of smoldering multiple myeloma (SMM, or asymptomatic MM) are:

    1. Serum monoclonal protein ≥3 g/dL OR
    2. Plasma cells in bone marrow (BM) ≥ 10% AND
    3. No evidence of end-organ damage (no anemia, bone lesions, renal dysfunction, hypercalcemia, or recurrent bacterial infections)

    Prognosis and risk for progression to MM are quite variable.

    Overall progression risk was 10%/year for the first five years, 3%/yr for the next five years, then 1%/year for the next ten years. Cumulative risk for progression was 73% at 15 years.

    • Provides prognostic information for patients.
    • Suggests patients who may need closer follow up.
    • Allows for stratification of patients on clinical trials potentially evaluating newer, targeted myeloma therapies.
    • Does not require FISH studies, cytogenetic, or MRI bone studies, which may add further discrimination but are not widely available; hence, generalizability is preserved in settings with limited availability of these studies.

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Patients with smoldering or asymptomatic MM are currently observed. However, clinical trials should be sought for appropriate patients given the rapid progress in development of novel active agents.

    Formula

    High Risk

    • BM plasmacytosis ≥10% AND
    • Serum monoclonal protein ≥3 g/dL

    Intermediate Risk

    • BM plasmacytosis ≥10% AND
    • Serum monoclonal protein <3 g/dL

    Low Risk

    • BM plasmacytosis <10% AND
    • Serum monoclonal protein ≥3 g/dL

    Facts & Figures

     

     

    Risk of progression

    Median time to progression

    At 5 years

    At 10 years

    At 15 years

    High Risk

    69%

    77%

    87%

    27 months (~2 years)

    Intermediate Risk

    43%

    64%

    70%

    93 months (~8 years)

    Low Risk

    15%

    33%

    39%

    228 months (~19 years)

    Evidence Appraisal

    The Mayo Clinic analyzed 3,549 patients with myeloma referred between 1970 and 1995. 276 (8%) fulfilled criteria for smoldering multiple myeloma (SMM).

    Patients’ bone marrows, labs and longitudinal records were reviewed. The end point was progression to active myeloma or amyloidosis requiring therapy.

    Pertinent outcomes:

    1. 85% of SMM patients died, median follow up 11.6 years.
    2. 57% developed active MM, with median survival after of 3.4 years.
    3. Cumulative probability of progression 51% at 5 years, 66% at 10 years, and 73% at 15 years.
    4. Risk of progression was 10% per year for the first 5 years, 3% per year for next 5 years, then 1% per year for the next 10 years.
    Dr. Robert A. Kyle

    About the Creator

    Robert A. Kyle, MD, is a professor of medicine and laboratory medicine and pathology at the Mayo Clinic in Rochester, Minnesota. He is widely regarded as a pioneer in multiple myeloma research, having published numerous critical papers on topics including monoclonal gammopathies, multiple myeloma, amyloidosis and macroglobulinemia.

    To view Dr. Robert A. Kyle's publications, visit PubMed

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