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Smoldering Myeloma: Understanding Risk Factors

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Published on November 26, 2019

Key Takeaways

  • Smoldering myeloma vs. active myeloma explained.
  • Criteria used for determining high risk smoldering myeloma.
  • Deciding if early treatment will give the best outcome.  

Leading multiple myeloma expert Dr. Krina Patel joined Patient Power in Houston, Texas to describe the early precursors for myeloma, and the difference between active and smoldering myeloma. Dr. Patel also explains what criteria is used to determine whether a patient is high risk for developing symptomatic myeloma, and patient outcomes with early intervention. Watch now to learn from a myeloma expert.

This town hall meeting is sponsored by Janssen Biotech, Inc. and Karyopharm Therapeutics with additional support to our partner, Myeloma Crowd (MCR), from Takeda Oncology and Foundation Medicine. These organizations have no editorial control, and Patient Power is solely responsible for the content. It is produced by Patient Power in partnership with The University of Texas MD Anderson Cancer Center.

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Transcript |

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jack Aiello:                 

Dr. Patel, can you help us understand what smoldering myeloma is and how is high risk determined? We use high risk in multiple myeloma as well, but they are different. 

Dr. Patel:

Sure. So, of course, unlike other cancers, there are maybe a few other cancers where we detect early precursors for myeloma, MGUS to smoldering to actual myeloma that needs treatment. 

In 2014, some of our rules changed of what’s considered smoldering versus actual myeloma. It used to be the CRAB criteria, where you had organ involvement. In 2014, we added light chain ratios of greater than 100 or if you had MRI changes, specific MRI changes, we would say you have myeloma and now, you need to start treatment. So, smoldering changed. 

What we were trying to find out is how do we find patients who have high-risk smoldering, meaning that their likelihood of becoming symptomatic myeloma in the next two years is high enough that we want to treat them before they actually get organ involvement or problems. So, one is quality of life. We don’t want people to get broken bones before we start treatment if we can help that. 

Second, if we can prolong life, of course, that’s where we think maybe this idea of cure, eventually we can do it before people have any problems. I think there have been multiple different ways of looking at what high risk is. 

There are criteria like the Spanish criteria, where they include looking at flow cytometry of the bone marrow biopsy, but not everywhere can do that. It’s a little bit hard. It’s a harder technique to make sure everyone gets the same answers. 

 

So, what was presented at ASCO recently and it’s something that’s been looked atit was using the 20/2/20 rule. So, if you have 20 percent in your bone marrow, even though it’s smolderingremember, 60 percent or higher means that you actually have active myeloma, that we would start treatment, but between 10 percent and 60 percent is considered smoldering. 

So, now, if you have 20 percent to 60 percent, that could be a risk factor. The other two is if you have more than 2 grams of the monoclonal protein that we look at. Then the third is 20the light chain ratio. If your ratio is greater than 20remember 100, you’re automatically considered as myeloma. But if it’s greater than 20, those are the three risk factors we look at. 

If you have two or more of those when you’re diagnosed as smoldering, we now consider that high risk. It’s about a 49 percent to 50 percent chance that in two years, you’re going to have active myeloma that needs treatment. So, the question is if we intervene early, does that change outcomes for those patients? 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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