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ASH 2024 | Smoldering myeloma: a case for early intervention?
Karthik Ramasamy, MBBS, MRCP, FRCPath, PhD, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, comments on whether there is a need for early intervention in smoldering myeloma, noting that a significant proportion of patients with monoclonal gammopathy of undetermined significance (MGUS) may progress to smoldering myeloma. Dr Ramasamy highlights the importance of assessing the toxicity profile of potential treatments in asymptomatic or mildly symptomatic patients before making a decision. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (AI generated)
Smoldering myeloma is a condition that has been detected in up to 10% of people with MGUS. This data came out of the iStopMM trial, which practically means in the UK where I practice, there’s probably between 150,000 to 200,000 people living with smoldering myeloma. Therefore, a case for early intervention has to be carefully made in this setting. What we are observing is that there is a group of patients with high-risk smoldering myeloma who do convert to active myeloma within a couple of years...
Smoldering myeloma is a condition that has been detected in up to 10% of people with MGUS. This data came out of the iStopMM trial, which practically means in the UK where I practice, there’s probably between 150,000 to 200,000 people living with smoldering myeloma. Therefore, a case for early intervention has to be carefully made in this setting. What we are observing is that there is a group of patients with high-risk smoldering myeloma who do convert to active myeloma within a couple of years. This staging system has been refined by the International Myeloma Working Group. There are trials starting up looking at intervention of treatment combinations and comparing versus either observation or with alternative treatments. But critically, to convince the whole clinical community, a trial has to show an overall survival advantage. In addition to that, it has to show in patients with smoldering myeloma who have no symptoms or limited symptoms that the toxicity profile is acceptable for these patients. So we’re expecting this type of data to come through over the next few years, but we don’t have this data today to change clinical practice.
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GSK: Consultancy, Research Funding, Speakers Bureau; Takeda: Consultancy, Speakers Bureau; Sanofi: Consultancy, Research Funding, Speakers Bureau; Bristol Myers Squibb: Consultancy, Research Funding, Speakers Bureau; Amgen: Consultancy, Research Funding, Speakers Bureau; Adaptive Biotech: Consultancy, Speakers Bureau; Johnson and Johnson: Consultancy, Speakers Bureau; Menarini Stemline: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Recordati rare Disease: Consultancy, Speakers Bureau.
