Is aggressive treatment of smoldering myeloma the path to curing myeloma?

Abstract

Smoldering multiple myeloma (SMM) is an asymptomatic condition that precedes newly diagnosed multiple myeloma (ND MM) and is present in ~1 of 200 individuals (0.5%) aged >40 years.1 The optimal management of patients with high-risk SMM (HR-SMM) remains controversial. Among proponents of early intervention in HR-SMM, there are predominantly 2 strategies that have been tested in clinical trials: 1 with low-intensity regimens, such as lenalidomide and dexamethasone,2,3 aimed at preventing morbidites such as fractures and renal failure, and another strategy which instead uses intensive regimens with the aim of cure. Intensive approaches include multidrug combination induction therapy with or without high-dose melphalan and autologous hematopoietic cell transplantation (HDM-AHCT).4-6 An important distinction between these 2 strategies is that although the former has been subjected to randomized controlled trials (RCTs) against observation, the latter, to date, has only been tested in single-arm studies.