Smoldering multiple myeloma - Past, present, and future

Hashim Mann; Vatsala Katiyar; Cindy Varga; Raymond L Comenzo

doi:10.1016/j.blre.2021.100869

Smoldering multiple myeloma - Past, present, and future

Blood Rev. 2022 Mar:52:100869. doi: 10.1016/j.blre.2021.100869. Epub 2021 Jul 22.

Authors

Hashim Mann¹, Vatsala Katiyar², Cindy Varga³, Raymond L Comenzo³

Affiliations

¹ Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA; The John Conant Davis Myeloma and Amyloid Program, Tufts Medical Center, Boston, MA, USA. Electronic address: hmann@tuftsmedicalcenter.org.
² Division of Hematology/Oncology, Brown Cancer Center, University of Louisville, Louisville, KY, USA.
³ Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA; The John Conant Davis Myeloma and Amyloid Program, Tufts Medical Center, Boston, MA, USA.

PMID: 34312016
DOI: 10.1016/j.blre.2021.100869

Abstract

Smoldering multiple myeloma (SMM) routinely precedes the development of multiple myeloma. While some patients experience aggressive disease, others have more indolent courses akin to those with monoclonal gammopathy of undetermined significance. Much effort has been made to understand the pathobiological basis of this heterogeneity. Scientific advancements have led to the emergence of various clinical and genomic markers of relevance, translating into evolution of disease definitions over time. More recently, the interest in manipulation of biological pathways has intensified in a bid to stall or halt disease progression. Studies with lenalidomide have exemplified the promise of early intervention, whereas numerous therapeutic approaches remain the subject of ongoing clinical investigation. This review summarizes the historic progress made in defining SMM as a distinct clinicopathologic entity, provides a critical appraisal of the evidence guiding risk assessment, and suggests a pragmatic approach to its modern-day management. Finally, an overview of developments on the horizon is also provided.

Keywords: Dexamethasone; Lenalidomide; Monoclonal gammopathy of undetermined significance; Multiple myeloma; Risk stratification; Smoldering multiple myeloma.

Publication types

Review

MeSH terms

Disease Progression
Humans
Monoclonal Gammopathy of Undetermined Significance* / etiology
Monoclonal Gammopathy of Undetermined Significance* / genetics
Multiple Myeloma* / etiology
Multiple Myeloma* / genetics
Risk Assessment
Risk Factors
Smoldering Multiple Myeloma* / etiology
Smoldering Multiple Myeloma* / genetics