How does one define high-risk smoldering or asymptomatic multiple myeloma?

FAQ Library published on November 6, 2014
Download Transcript Download Audio
Sagar Lonial, MD, FACP
Chair and Professor
Department of Hematology and Medical Oncology
Chief Medical Officer
Winship Cancer Institute
Emory University School of Medicine
Atlanta, Georgia
Hello, I am Dr. Sagar Lonial from the Winship Cancer Institute of Emory University in Atlanta, Georgia. A question that I am frequently asked is, “How does one define high-risk smoldering or asymptomatic multiple myeloma?” And the easiest way to put this definition together is really to look at the current ECOG/Mayo criteria that allows us to use easily accessible clinical information to make this diagnosis, and that is there are three criteria that we look at: 1) Does the patient have greater than 10% plasma cells? 2) Is the M-protein greater than 3 gm/dL? 3) Is the free light chain ratio greater than 8 or less than 0.125? If the answer to all three of those questions is ‘yes,’ then the patient fits into the high-risk smoldering myeloma category. If only two of those three are positive, then they fall into the intermediate-risk category, and if only one of those three is positive, they fall into the low-risk smoldering category. Now, it is important to realize that those three have different times to progression to symptomatic myeloma. The high risk has an average time of somewhere between 2 and 3 years of progressing to myeloma. The intermediate risk has an average time of between 3 and 5 years to progression to symptomatic myeloma, and the low risk has a very, very low risk of progression with the median not having been reached with a median followup of 10 years. So, using these three simple tests, one can identify the risk of progression of asymptomatic to symptomatic myeloma and help to make therapeutic decisions. Thank you.

Reviewed on January 17, 2017 for clinical relevance.

Last modified: February 8, 2017
Related Items by Author
Are there certain agents which can be selected for treatment which may lessen immunosuppression?
Sagar Lonial, MD, FACP
FAQ Library published on May 20, 2020
Will clinical trials continue to enroll during this time?
Sagar Lonial, MD, FACP
FAQ Library published on May 20, 2020
What education or instruction are you providing to your patients with myeloma who are already immunocompromised?
Sagar Lonial, MD, FACP
FAQ Library published on May 20, 2020
How are you managing care delivery during the COVID-19 pandemic?
Sagar Lonial, MD, FACP
FAQ Library published on May 20, 2020
Practice-changing trials to watch for in 2018
Sagar Lonial, MD, FACP
FAQ Library published on January 24, 2018
A key educational message from ASH 2017
Sagar Lonial, MD, FACP
FAQ Library published on January 12, 2018
Is there a role for Bcl-2 directed treatment for patients with translocation 11;14?
Sagar Lonial, MD, FACP
FAQ Library published on October 11, 2017
How will the new IMWG definition of active multiple myeloma impact clinical practice?
Sagar Lonial, MD, FACP
FAQ Library published on August 18, 2016
How do we determine which patients will benefit the most from treatment with daratumumab and elotuzumab?
Sagar Lonial, MD, FACP
FAQ Library published on July 18, 2016
What is the role of SPEP, UPEP and immunofixation in managing multiple myeloma patients?
Sagar Lonial, MD, FACP
FAQ Library published on July 6, 2016