EHA 2023 | Identifying high-risk patients with SMM & MGUS to prevent progression to active myeloma

Today, there is an increasing and important debate about the different myeloma precursor conditions. Because, of course, while there is a true revolution in the management and in the treatment of multiple myeloma, one would like to better understand these precursor conditions whether MGUS – monoclonal gammopathy of unknown or undetermined/undefined significance – or smoldering multiple myeloma. So, it is clear that if you would like to avoid the development of multiple myeloma, one would like to better understand these precursor conditions. And definitely now we do have some accumulating evidence about the transition from these precursor conditions into symptomatic multiple myeloma, and that is now providing the basis for developing treatments to prevent or anticipate the development of symptomatic multiple myeloma with organ dysfunction. And this is, for instance, the rationale for developing, and for some ongoing protocols, in the field of high-risk smoldering multiple myeloma.

So, it is very exciting to see that probably in the next few years we may be able to identify those high-risk patients with precursor conditions and maybe cure them by stopping the disease very early and avoid all the complications. Obviously this is work in progress, and I don’t believe that today there is any universal recommendation or consensus to treat these precursor conditions outside clinical trial. But definitely, at some point, I believe that is a goal that we would love to achieve, similar to what you see in other malignant diseases where we’re screening with early intervention, you can avoid the dismal outcome of the cancer by itself, like in breast cancer, colon cancer, cervical cancer et cetera. So this is a new era, I would say, in the overall landscape of blood cancers.