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Asymptomatic Myeloma Prognosis

Calculators  Multiple body systems
The asymptomatic myeloma prognosis calculator helps predict the risk of progression of asymptomatic multiple myeloma to active myeloma or amyloidosis.
Plasmacytosis of Bone marrow
Average percentage from core biopsy and bone marrow aspirate
≥10% 0
<10% 1
Serum monoclonal protein
Upon serum protein electrophoresis
≥3 10
<3 20
Result:

Background

Measured Factor
Risk of progression from asymptomatic multiple myeloma to active myeloma or amyloidosis.
Measured Factor Disease
  • Active multiple myeloma
  • amyloidosis
Measured Factor Detail
The Asymptomatic Myeloma Prognosis calculator helps classify patients with smoldering multiple myeloma (MM) into 3 groups with different risks of progression to active MM or amyloidosis. The calculator takes into consideration the proportion of bone marrow plasma cells (<10% or ≥10%) and the serum monoclonal protein level (<3 or ≥3 g/dL) at diagnosis. Based on these two factors, patients are classified as low, intermediate or high risk of progression. Patients with low risk have a 15% risk of progression at 5 years, patients with intermediate risk have a 43% risk at 5 years, and those with high risk have a 69% risk at 5 years. The calculator also provides risk percentages at 10 and 15 years and time to progression. Additionally, when the proportion of bone marrow plasma cells is <10% and the serum monoclonal protein level is <3 g/dL, there is no risk because patient does not meet criteria for asymptomatic myeloma.
Speciality
Oncologist
Body System
Multiple body systems
Measured Factor High Impact
  • High risk of progression to active multiple myeloma or amyloidosis.
Process
The proportion of bone marrow plasma cells is measured by bone marrow aspirate and core biopsy. The serum monoclonal protein level is measured by blood test.

Result Interpretation

Ranges Ranges
  • Critical High: Serum monoclonal protein ≥3 g/dL AND plasma cells in bone marrow (BM) ≥10%
  • Normal: Serum monoclonal protein <3 g/dL AND plasma cells in bone marrow (BM) < 10%. It means the patient does not meet the criteria for asymptomatic myeloma, and thus the risk of progression to active myeloma or amyloidosis is none.
  • Normal Adult Male: Serum monoclonal protein <3 g/dL AND plasma cells in bone marrow (BM) < 10%. It means the patient does not meet the criteria for asymptomatic myeloma, and thus the risk of progression to active myeloma or amyloidosis is none.
  • Normal Adult Female: Serum monoclonal protein <3 g/dL AND plasma cells in bone marrow (BM) < 10%. It means the patient does not meet the criteria for asymptomatic myeloma, and thus the risk of progression to active myeloma or amyloidosis is none.
  • Normal Geriatric Male: Serum monoclonal protein <3 g/dL AND plasma cells in bone marrow (BM) < 10%. It means the patient does not meet the criteria for asymptomatic myeloma, and thus the risk of progression to active myeloma or amyloidosis is none.
  • Normal Geriatric Female: Serum monoclonal protein <3 g/dL AND plasma cells in bone marrow (BM) < 10%. It means the patient does not meet the criteria for asymptomatic myeloma, and thus the risk of progression to active myeloma or amyloidosis is none.
Result High Conditions
  • Active multiple myeloma
  • amyloidosis

Studies

Study Validation 1
Retrospective study aimed at evaluating the International Myeloma Working Group (IMWG) criteria for the diagnosis of multiple myeloma in patients diagnosed with asymptomatic (smoldering) multiple myeloma (AMM). The analysis included 216 patients with AMM, a median follow up of 4 years and had all data available to calculate the IMWG criteria. The criteria obtained from the IMWG was compared to the prognostic risk calculated in the asymptomatic myeloma prognosis calculator. Per the asymptomatic myeloma prognosis calculator developed by researchers at the Mayo Clinic ((Kyle et al NEJM 2007), 11.5% of patients had ≥10% of plasma and ≥3 g/dL of M-spike and thus were considered high risk. Among these high-risk patients, the new IMWG criteria found 15% to fulfill the criteria for symptomatic MM. From the intermediate risk group identified by the asymptomatic myeloma prognosis calculator, the IMWG identified 12% to be symptomatic MM. Therefore, the IMWG criteria identified a very high risk group, even among patients at intermediate risk per the asymptomatic myeloma prognosis calculator. In conclusion, the new criteria of IMWG was found to be more sensitive in the identification of AMM patients with very high risk for progression who may need immediate treatment.
References: 2
Study Additional 1
Retrospective, observation study assessed the best couse of treatment for patients with smoldering multiple myeloma, a condition in which the bone marrow contains increased number of blast cells but the patients are asymptomatic and remain so for a long time without therapy. Researchers reviewed the records of all Mayo Clinic patients with a confirmed diagnosis of multiple myeloma before January, 1974. Diagnosis was based on abnormal plasma cells in the bone marrow (≥10%) and/or monoclonal protein in the serum (≥3 g/L). None of the patients included in the review had previous chemotherapy treatment. During the study period, 6 cases of fulfilled the criteria for the diagnosis of multiple myeloma. However, none of the cases developed anemia, lytic bone lesions, hypercalcemia, renal failure, or other manifestations of multiple myeloma during the period of observation (5  or more years). Based on these results, researchers concluded patients presenting with smoldering myeloma should be followed closely instead of being treated with chemotherapy that can lead to other complications.
References: 3
Study Additional 2
This article focused on smoldering multiple myeloma (MM) and evaluated the diagnostic work-up and prognostic factors available to predict progression to symptomatic MM. Smoldering MM is asymptomatic and is characterized by the presence of ≥ 30 g/L serum M-protein and/or ≥ 10% bone marrow plasma cell infiltration (BMPC). Progression to active multiple myeloma is not uniform and there are various prognostic parameters available to determine this progression. A analysis performed by the Mayo Clinic group on 276 smoldering MM patients showed the annual risk of progression was 10% per year for the first 5 years, 5% per year during the following 5 years, and 1% per year after the 10th year. Prediction of progression was found to be related to serum M-protein and BMPCs. Based on the updated information published to this date by the International Myeloma Working Group, expert opinion is to "watch and wait" patients with low risk, while patients with high risk should be considered as active MM patients.
References: 4
Study Additional 3
Review paper published in 2014 discussing recent advances in the management and diagnosis of smoldering multiple myeloma (SMM) and the different risk models that help predict the progression to symptomatic disease. The standard of care for SMM has been no treatment and there have been different trials evaluating early treatment, but no evidence in favor of early treatment has been shown. A main limitation of these studies was the lack of stratification according to risk and therefore it was not possible to identify subgroups of patients that could potentially benefit. To examine this closely, a randomized trial was completed assessing the utility of early treatment in patients with high and ultra-high-risk smoldering multiple myeloma (SMM). The risk of progression to active multiple myeloma is not uniform and normally asymptomatic patients receive no treatment, however patients with high and ultra-high risk of progression can benefit from early treatment. Patients were randomized to receive early treatment with lenalidomide plus dexamethasone vs. observation. After a median follow up of 40 months, results showed a median time to progression significantly longer in patients receiving early treatment than in patients under observation (no patients reached progression vs. 21 months, respectively; p<0.001). One of the most importance findings was that the 3-year survival rate was higher among patients who received early treatment (p=0.03). In summary, high risk SMM patients should be identified and targeted for early treatment before they develop myeloma-related symptomatology.
References: 5

Authors

Robert A. Kyle, MD, is a professor at Mayo Clinic in Rochester, Minnesota. Dr. Kyle completed his medical degree at the Northwestern University Feinberg School of Medicine in 1952. In 1955 he became an Internal Medicine fellow at the Mayo Graduate School of Medicine, Mayo Clinic College of Medicine and in 1961 completed a Post-doctoral fellowship in Research at the National Cancer Institute. At this time, Dr. Kyle focuses entirely on research and his interests lie on multiple myeloma research.
https://www.mayoclinic.org/biographies/kyle-robert-a-m-d/bio-20054269

References

  1. Kyle RA, Remstein ED, Therneau TM, Dispenzieri A, Kurtin PJ, Hodnefield JM, et al. Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma. N Engl J Med. 2007 Jun 21;356(25):2582-90.
  2. Kastritis E, Terpos E, Roussou M, Koutoulidis V, Giannouli S, Gavriatopoulou M, et al. Validation of the Novel Criteria for the Definition of Symptomatic Myeloma: A Single Center Experience in 216 Patients with the Previous Diagnosis of Asymptomatic Disease. Blood. 2015:126:4251. URL: http://www.bloodjournal.org/content/126/...
  3. Kyle RA, Greipp PR. Smoldering multiple myeloma. N Engl J Med. 1980 Jun 12;302(24):1347-9.
  4. Gentile M, Offidani M, Vigna E, Corvatta L, Recchia AG, Morabito L, et al. Smoldering multiple myeloma: to treat or not to treat. Expert Opin Pharmacother. 2015 Apr;16(6):785-90.
  5. Mateos MV. Advances in the management of asymptomatic myeloma. Curr Opin Oncol. 2014 Nov;26(6):670-6.