Smouldering myeloma: detection, risk stratification and defining a new standard of care

María-Victoria Mateos, MD, PhD of University Hospital of Salamanca, Salamanca, Spain discusses her workshop on early clinical detection and intervention of multiple myeloma (MM) at the 2016 European Multiple Myeloma Academy (EMMA) in Madrid, Spain. Dr Mateos explains that the focus was the definition of and standard of care for smouldering myeloma. The standard of care in terms of treatment is observation but, as Dr Mateos points out, a sub-group of patients who are at ultra high-risk of progression to myeloma, may now be considered as myeloma patients and therefore receive therapy. In general, patients should be stratified according to risk of progression whereby low- and intermediate-risk patients have to be seen once or twice a year. The Phase III QuiRedex trial (NCT00480363) comparing early treatment with lenalidomide with dexamethasone versus observation, showed that the benefit for high-risk patients receiving early treatment is evident in terms of time to progression and overall survival (OS). The conclusion, therefore, is that high-risk smouldering myeloma patients should be treated early with lenalidomide and dexamethasone. Finally, Dr Mateos explains that, in the near future, the definition of multiple myeloma should be expanded to include more smouldering myeloma patients with the use of biomarkers prediciting risk of progression.
This programme has been supported by Celgene and Amgen through an unrestricted educational grant to the Video Journal of Hematological Oncology.

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