3 research outputs found
What Is New in the Treatment of Smoldering Multiple Myeloma?
Smoldering multiple myeloma (SMM), an asymptomatic plasma cell neoplasm, is currently
diagnosed according to the updated IMWG criteria, which reflect an intermediate tumor mass
between monoclonal gammopathy of undetermined significance (MGUS) and active MM. However,
SMM is a heterogeneous entity and individual case may go from an “MGUS-like” behavior to “early
MM” with rapid transformation into symptomatic disease. This wide range of clinical outcomes
poses challenges for prognostication and management of individual patients. However, initial studies
showed a benefit in terms of progression or even survival for early treatment of high-risk SMM
patients. While outside of clinical trials the conventional approach to SMM generally remains that of
close observation, these studies raised the question of whether early treatment should be offered in
high-risk patients, prompting evaluation of several different therapeutic approaches with different
goals. While delay of progression to MM with a non-toxic treatment is clearly achievable by early
treatment, a convincing survival benefit still needs to be proven by independent studies. Furthermore,
if SMM is to be considered less biologically complex than MM, early treatment may offer the chance
of cure that is currently not within reach of any active MM treatment. In this paper, we present
updated results of completed or ongoing clinical trials in SMM treatment, highlighting areas of
uncertainty and critical issues that will need to be addressed in the near future before the “watch and
wait” paradigm in SMM is abandoned in favor of early treatmen