Smoldering Multiple Myeloma is an asymptomatic disease that occurs due to the presence of a serum monoclonal component between 10% and 60% of plasma cells in the bone marrow. It is considered to be an early precursor to a rare type of blood cancer, otherwise defined as Multiple Myeloma. In this case, the cancer cells are responsible for producing specific proteins that can be measured in both blood and urine. Note that these proteins only show up prior to any symptoms of cancer.
How can Smoldering Multiple Myeloma be detected?
It is diagnosed by the elevation of the serum total proteins. This precancerous condition leads to the alteration of proteins in the blood and the considerable increase of plasma cells in the bone marrow. Unfortunately, no such appropriate symptoms can be observed to identify the condition at its early stages.
With the increase of the serum total proteins, a serum protein electrophoresis is conducted to determine the presence of a monoclonal component, and if that is higher than 3g/dL, doctors perform a bone marrow aspirate. If the results indicate that the plasma cells within the bone marrow are between 10% and 60%, SMM can be suspected. Patients with this condition must also undergo testing of serum-free light chain ratio and an MRI. Based on the medical test results, a bine marrow biopsy will finally be conducted to check for cancerous cells.
What are the risk factors of developing Smoldering Multiple Myeloma?
Scientists and researchers have yet not come up with a definite cause that leads to the development of this condition, but age has been considered to be a potential risk factor because people who are diagnosed with this disease are mostly of 65 years and above. It has also been found out that African Americans have a greater risk (twice) of getting this disease than Caucasians. Lastly, men are more at risk than women in this case.
When can treatment be considered for Smoldering Multiple Myeloma?
If the medical test results indicate that the serum-free light chain ratio is more significant than 100, treatment should be considered. However, if the bone marrow consists of 60% plasma cells, and the MRI has identified 2 or more focal lesions, it is also a cue. Though it is quite difficult to assess these conditions given that the patients are asymptomatic, the above inferences clearly suggest that the patient is progressing towards developing Active Multiple Myeloma.
Treatment Approaches of Smoldering Multiple Myeloma
Typically, there are two treatment approaches to SMM. The first one is an attempt to delay the progression to active disease. Drugs like Lenalidomide and Dexamethasone, along with other therapies like checkpoint inhibitors and monoclonal antibodies. SLAMF7 is present on the surface of plasma cells and natural killer cells that can be targeted by Elotuzumab.
Mention may also be made of Daratumumab 400mg, classified as a human IgG1k monoclonal antibody, and helpful for targeting the CD38 receptor that is expressed in high amounts on the surface of Myeloma cells. Single-agent Daratumumab is also seen to delay progression.
The second approach is to treat asymptomatic Multiple Myeloma. Carfilzomib, Lenalidomide, and Dexamethasone are seen to be well-tolerated by patients diagnosed with high-risk Smoldering Multiple Myeloma.
In low doses, Bortezomib 2mg or Bortezomib 3.5mg are seen to be effective in increasing the bone marrow density of SMM patients. Alkylating agents like Melphalan 50 mg have shown promising results in treating Smoldering Multiple Myeloma in patients between 65 to 75 years of age, along with prednisone and thalidomide.
Conclusion
Doctors can detect Multiple Myeloma even at the smoldering stage with the help of a blood test. Other than this, a urinalysis or CT scan may also be helpful. If SMM progresses into Stage 1 Multiple Myeloma, the doctor may consider treatment options like radiation therapy and chemotherapy. A bone marrow transplant is also considered in many cases. There are currently many medical research and studies conducted in different parts of the world to open up possibilities for the treatment of Smoldering Multiple Myeloma and prevent it from progressing into active cancer. Several patients who have been diagnosed with the condition consider volunteering in clinical trials as well.
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