Kyle et al identified different groups of patients with smoldering multiple myeloma who had a different rate of progression to symptomatic disease. These can help identify patients who may benefit from more aggressive management. The authors are from the Mayo Clinic.
Terms:
(1) smoldering myeloma: serum monoclonal protein >= 3 g/dL and/or >= 10% plasma cells in the bone marrow without end-organ damage
(2) active myeloma: end-organ damage plus one or more of the following: plasmacytoma, increased plasma cells in the bone marrow, monoclonal protein in serum, monoclonal protein in urine
Types of end-organ damage:
(1) hypercalcemia
(2) renal insufficiency
(3) anemia
(4) bone lesions
(5) recurrent bacterial infections
Endpoints indicative of progression: active multiple myeloma or amyloidosis
Parameters:
(1) percent of plasma cells in the bone marrow
(2) serum concentration of monoclonal protein in g/dL
|
Percent Plasma Cells |
Serum Monoclonal Protein |
Group |
|
>= 10% |
>= 3 g/dL |
1 |
|
>= 10% |
< 3 g/dL |
2 |
|
< 10% |
>= 3 g/dL |
3 |
|
Group |
Cumulative Probability of Progression at 15 Years |
Median Time to Progression |
|
1 |
87% |
2 years |
|
2 |
70% |
8 years |
|
3 |
39% |
19 years |
Additional risk factors at diagnosis (from univariate analysis, page 2586):
(1) high level of serum monoclonal protein
(2) presence of IgA monoclonal protein
(3) presence of urinary light chains
(4) plasma cells in the bone marrow >= 20%
(5) reduction in the serum levels of normal immunoglobulins
(6) sheets of plasma cells spanning the interfatty spaces in the bone marrow
Purpose: To evaluate a patient with smoldering (asymptomatic) myeloma based on the prognostic groups of Kyle et al.
Specialty: Hematology Oncology
Objective: severity, prognosis, stage
ICD-10: C90,
