Preventing Multiple Myeloma: A Promising New Approach For People at High Risk

While it's early on, the implications of this, say the trial's authors, could be significant, and has started a conversation about screening for this incurable cancer, something not currently done.

"So far we have not screened for smoldering multiple myeloma because there was no therapy," explains one of the lead authors, Dr Vincent Rajkumar of the Mayo Clinic. "Now, we must consider screening at least in high risk populations. I would recommend screening for smoldering multiple myeloma in persons with two or more affected first degree relatives with myeloma, and in African Americans with one affected relative with myeloma. Screening should be considered starting about 10 years prior to the age at diagnosis of the affected relative."

Not everyone with smoldering multiple myeloma has the same risk of developing full blown cancer. Once diagnosed with SMM, patients are divided into low risk, moderate risk or high risk of progressing to multiple myeloma. Those at high risk seemed to benefit the most from preemptively taking Revlimid, but those at moderate risk also saw their chances of full multiple myeloma decrease.

"The benefit to patients with an intermediate risk is very interesting," Dr Sagar Lonial, one of the lead authors, told SurvivorNet. "If we can prove benefit to those patients that's a big deal, because no one is really looking at that group.

For high risk this is practice changing, for intermediate risk, it's provocative, and could well change practice in the long term as well."

This could be big news for the estimated 4,400 people that are diagnosed with smoldering multiple myeloma in the United States each year. Around 10 percent of those people will go on to develop full multiple myeloma annually. Those with high risk have a 50 percent chance of progressing to the active disease in two years. While survival rates for multiple myeloma have steadily increased over the last few years thanks to the availability of several new therapies, there still remains no cure, and it's considered a chronic condition to which most patients will eventually succumb. Revlimid, the study suggests, while not being a cure, could provide a way to significantly slow down this chain of events. "This isn't putting people into remission," Dr Lonial points out, “but is stalling progression." This could give patients additional years of progression-free, and overall, survival.

Despite this encouraging news, the practicalities of taking lenalidomide continuously should be considered, and a proportion of the trial's patients had to stop taking the drug as the side effects — such as diarrhea and constipation — became too much for them to tolerate. It should also be noted that Revlimid isn't cheap, and it's far too early to say whether insurance companies would pay for its continuous use as a preventative measure. But Dr Lonial points out that patients were taken off the drug after two years, and still had increased survival rates after five years, suggesting that perhaps it still might be possible to significantly slow down progression to multiple myeloma without patients having to take a pill for the rest of their lives.

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