Smoldering multiple myeloma: taking the narrow over the wide path?

Area of Science:

• Hematology
• Oncology
• Translational Medicine

Background:

• Smoldering multiple myeloma (MM) is an asymptomatic plasma cell disorder.
• It is considered a premalignant condition with a risk of progression to symptomatic MM.
• Current risk stratification is poorly defined, leading to proposed interventions.

Purpose of the Study:

• To evaluate the risks and benefits of prospective interventional trials for smoldering MM.
• To advocate for a "wait and watch" approach combined with observational biological studies.
• To identify biomarkers for predicting progression to symptomatic MM.

Main Methods:

• Review of current approaches to smoldering MM management.
• Analysis of the potential harms of early intervention.
• Proposal for enrollment in observational studies focusing on plasma cell biology.

Main Results:

• Prospective interventional trials may be harmful for smoldering MM patients.
• A "wait and watch" approach is favored.
• Observational studies can yield crucial biological insights.

Conclusions:

• Early intervention in smoldering MM is not recommended.
• Observational studies are essential for understanding disease progression.
• Plasma cell genomics, epigenetics, and immune microenvironment are key areas for future research to identify high-risk patients.