Do No Harm: What Smoldering Myeloma Teaches Us

Smoldering multiple myeloma , a potential precursor to multiple myeloma , has become a controversial topic. Some people diagnosed with SMM will live their whole lives without ever developing MM, while others will develop it quickly.

Despite the seminal importance of this work, from today's perspective the 2007 study might just as well have been describing a different disease. Back then people were diagnosed with SMM if their blood work detected a monoclonal protein and a follow-up bone marrow biopsy found at least 10% plasma cells . If there were no signs of end-organ damage and an x-ray showed no fractures or lesions in the bones, the diagnosis was determined to be SMM.

Doctors routinely keep showing slides from Kyle's pivotal work to describe the natural history of SMM and to justify the need for treatment, and trials continue to use outdated progression prediction models. In my opinion, as people with MM keep living longer and treatments for MM keep getting better, the threshold for intervening with asymptomatic, healthy people with SMM should be getting higher, not lower.

For example, plasma cell diseases are not linked to low bone density or auto-immune diseases, yet these labs are sent routinely as part of a workup for those conditions, leading to increasing anxiety and costs.

Myeloma Plasma Cell Myeloma Blood Bones Cancer Malignant Neoplasia Carcinoma Malignant Neoplasm Smoldering Multiple Myeloma Smoldering Multiple Myeloma (SMM) X-Ray Xray Bone Density Bone Mineral Density BMD Bone Marrow Medulla Ossea Cancer Risk Kidney Cancer Renal Cancer Biologic Therapy Biologics Plasma Toxicology Toxicity Poisoning Toxins

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