Clinical Course and Prognosis of Smoldering (Asymptomatic) Multiple Myeloma
Robert A. Kyle, M.D., Ellen D. Remstein, M.D., Terry M. Therneau, Ph.D., Angela Dispenzieri, M.D., Paul J. Kurtin, M.D., Janice M. Hodnefield, M.S., Dirk R. Larson, M.S., Matthew F. Plevak, B.S., Diane F. Jelinek, Ph.D., Rafael Fonseca, M.D., Lee Joseph Melton, III, M.D., and S. Vincent Rajkumar, M.D.
Background Smoldering (asymptomatic) multiple myeloma is anasymptomatic plasma-cell proliferative disorder associated witha high risk of progression to symptomatic multiple myeloma oramyloidosis. Prognostic factors for the progression and outcomeof this disease are unclear.
Methods We searched a computerized database and reviewed themedical records of all patients at Mayo Clinic who fulfilledthe criteria of the International Myeloma Working Group forthe diagnosis of smoldering multiple myeloma between 1970 and1995. Bone marrow aspirate and biopsy specimens were studied,and patients were followed throughout the course of disease.
Results During the 26-year period, 276 patients fulfilled thecriteria for smoldering multiple myeloma. During 2131 cumulativeperson-years of follow-up, symptomatic multiple myeloma or amyloidosisdeveloped in 163 persons (59%). The overall risk of progressionwas 10% per year for the first 5 years, approximately 3% peryear for the next 5 years, and 1% per year for the last 10 years;the cumulative probability of progression was 73% at 15 years.At diagnosis, significant risk factors for progression includedthe serum level and type of monoclonal protein, the presenceof urinary light chain, the extent and pattern of bone marrowinvolvement, and the reduction in uninvolved immunoglobulins.The proportion of plasma cells in the bone marrow and the serummonoclonal protein level were combined to create a risk-stratificationmodel with three distinct prognostic groups.
Conclusions The risk of progression from smoldering multiplemyeloma to symptomatic disease is related to the proportionof bone marrow plasma cells and the serum monoclonal proteinlevel at diagnosis.
Source Information
From the Division of Hematology (R.A.K., A.D., R.F., S.V.R.), the Department of Laboratory Medicine and Pathology (E.D.R., P.J.K., J.M.H.), the Division of Biostatistics (T.M.T., D.R.L., M.F.P.), the Department of Immunology (D.F.J.), and the Department of Health Sciences Research (L.J.M.), Mayo Clinic, Rochester, MN.
Address reprint requests to Dr. Kyle at the Division of Hematology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, or at kyle.robert{at}mayo.edu.
Smoldering Multiple Myeloma
Prasad H. K., Zhan F., Shaughnessy J., Focosi D., Andrews A. T., Kyle R. A., Rajkumar S. V.
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N Engl J Med 2007;
357:1048-1050, Sep 6, 2007.
Correspondence
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