There’s a word used for a disease that proceeds myeloma that sounds frightening. The word is “smoldering”. Smoldering multiple myeloma is a disease that is very close to becoming active myeloma, but does not have any symptoms. “Just by its name, it’s smoldering—it’s almost there—to light up the fire, to become active disease,” says Dr. Irene Ghobrial, myeloma specialist from the Dana Farber Cancer Institute. Almost all patients diagnosed with active multiple myeloma had smoldering myeloma previously, but most don’t know it. Smoldering myeloma is symptomless, but is characterized by higher levels of abnormal proteins in the blood and plasma cells that make up greater than 10% of the bone marrow.
The chance of progressing to malignant myeloma differs based on the riskiness of the smoldering myeloma. Patients with smoldering myeloma typically have a 10% lifetime chance of progressing to active multiple myeloma, but patients with high risk smoldering myeloma have a 50% chance of progressing to active multiple myeloma within just two years following diagnosis.
Doctors are making advances on how to diagnose and treat smoldering myeloma. There are two ways high risk smoldering multiple myeloma is diagnosed. First, the bone marrow is measured to see if it is made up of 10% or greater plasma cells. Second, the blood is measured for the presence of certain antibodies. Patients with these results in diagnostic tests should meet with their physicians to discuss potential early treatment options.
So once the diagnosis is made, how is high risk smoldering myeloma treated? The current approach is to “watch and wait.” However, waiting too long can produce active myeloma and serious symptoms. The changes in the blood and bone can eventually become worse, and end up affecting different parts of the body, producing symptoms like bone fractures and organ damage.
Once these injuries occur, patients are started on a three-phase myeloma treatment, which includes steroids, immune system-activating drugs, chemotherapy, and stem-cell transplantation. Researchers like Dr. Ghobrial, however, are working to develop treatments that can potentially cure patients of the disease before they develop serious symptoms or active myeloma. “We’ve done several clinical trials…by giving them an immune antibody that activates the immune system, and by killing the cells early, potentially we have a better response to therapy than when we wait for them to have too much disease burden [and] too many changes [to] immune suppression.”
It’s estimated the 3% of all adults over the age of 50 have evidence of the disease that precedes multiple myeloma.
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