Diagnosis and detection of smouldering multiple myeloma
Dr Elena Zamagni - University of Bologna, Bologna, Italy
We are going to speak about smouldering myeloma. I will focus on the fact that it’s very important to perform a correct diagnosis following the new International Myeloma Working Group criteria. When you have suspected smouldering myeloma you have to look very carefully at the event of skeletal disease with novel imaging techniques. So I will focus on the fact that it’s very important to use novel imaging techniques and not whole-body X-ray. Then it’s important to look at the bone marrow, so to look at the percentage of plasma cells in the bone marrow, and also in the laboratory test to pay attention to both serum free light chains and proteinuria. When you have looked at all these parameters then you can have a correct diagnosis and you are not risking to misdiagnose an active myeloma with smouldering myeloma.
Then you have to follow up the patient and you have to be aware of the fact that patients are at different risk of progression, so you have to establish the risk of each patient and to decide the follow-up, how frequently to perform the follow-up.
Are there any risk factors that can contribute to progression of the disease?
There are several risk factors: the quantity of M component, the presence of proteinuria. That’s why it’s very important also to check the presence or not of proteinuria, the eventual presence of cytogenetic abnormalities, the doubling time of the M component is a very important factor as well. You can eventually look by PET CT at the presence of focal lesions without osteolytic lesions. All these factors, if they are present and positive, are putting the patient at higher risk of progression.
What are the challenges to diagnosing smouldering myeloma?
That’s what I was telling about as it is an asymptomatic disease and some patients can have a prognosis similar to the people having MGUS. You have really to be careful in not mistaking the diagnosis. In this kind of patient it’s very, very important that the diagnostic work-up at the beginning. Once you have done this, you can be rather confident even to follow the patient like an MGUS or to put the patient in, for example, a clinical trial of treatment or to start to treat as an active patient.
