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How I treat smoldering multiple myeloma
#MMPMID25298034
Ghobrial IM
; Landgren O
Blood
2014[Nov]; 124
(23
): 3380-8
PMID25298034
show ga
Smoldering myeloma is a heterogeneous clinical entity where a subset of patients
has an indolent course of disease that mimics monoclonal gammopathy of undermined
significance, whereas others have a more aggressive course that has been
described as "early myeloma." It is defined as either serum M-protein ? 3 g/L or
? 10% monoclonal plasma cells in the bone marrow. There are currently no
molecular factors to differentiate risks of progression for these patients.
Current recommendations of therapy continue to be patient observation or patient
enrollment in clinical trials. However, new definitions of active multiple
myeloma recently agreed upon by the International Myeloma Working Group may alter
the timing of therapy. On the basis of emerging data of therapy in these
patients, it seems reasonable to believe that future recommendations for therapy
of patients with smoldering myeloma will become an increasingly important topic.
In this article, we review the current knowledge of this disease and risk factors
associated with progression. We also examine biological insights and alterations
that occur in the tumor clone and the surrounding bone marrow niche. Finally, we
review clinical trials that have been performed in these patients and provide
recommendations for follow-up of patients with this unique disease entity.
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