title: The road to treating smoldering multiple myeloma.
abstract: The management of smoldering multiple myeloma (SMM) has been a challenge to clinicians, ever since the condition was first characterized in 1980. While the risk of progression to symptomatic myeloma is greater for SMM (10% per year) compared to MGUS (1% per year), several SMM patients remain asymptomatic for years without evidence of disease progression. Early clinical trials focusing on early treatment of SMM have been equivocal with no clear benefit. However, the last decade has seen a greater understanding of the pathogenesis of plasma cell disorders, including SMM, and development of better therapeutics. A recent randomized trial has provided evidence of clinical benefit with early treatment of high-risk SMM. In this review, we summarize issues related to the early treatment of SMM including risk stratification and possible outcomes with therapy initiation. In the context of reviewing recent clinical trial data supporting early treatment, we define challenges faced by clinicians and provide future directions to the road to treating SMM.
authors.affiliation: Multiple Myeloma Section, Lymphoid Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: neha.korde@gmail.com.
authors.forename: Neha
authors.initials: N
authors.lastname: Korde
authors.affiliation: Multiple Myeloma Section, Lymphoid Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Sham
authors.initials: S
authors.lastname: Mailankody
authors.affiliation: Multiple Myeloma Section, Lymphoid Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Ola
authors.initials: O
authors.lastname: Landgren
mesh_terms: D058070:Asymptomatic Diseases; D002986:Clinical Trials as Topic; D018450:Disease Progression; D006801:Humans; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors
keywords: High-risk SMM; MGUS; Minimal residual disease; Monoclonal protein; Plasma cells