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International Myeloma Working Group risk stratification model for smoldering multiple myeloma (SMM)

Autores: Mateos, M. V.; Kumar, S. (Autor de correspondencia); Dimopoulos, M. A.; Gonzalez-Calle, V.; Kastritis, E.; Hajek, R.; De Larrea, C. F. ; Morgan, G. J. ; Merlini, G. ; Goldschmidt, H. ; Geraldes, C.; Gozzetti, A.; Kyriakou, C. ; Garderet, L.; Hansson, M.; Zamagni, E. ; Fantl, D.; Leleu, X.; Kim, B. S. ; Esteves, G.; Ludwig, H. ; Usmani, S.; Min, C. K.; Qi, M. ; Ukropec, J. ; Weiss, B. M. ; Rajkumar, S. V.; Durie, B. G. M. ; San Miguel Izquierdo, Jesús
Título de la revista: BLOOD CANCER JOURNAL
ISSN: 2044-5385
Volumen: 10
Número: 10
Fecha de publicación: 2020
Smoldering multiple myeloma (SMM) is an asymptomatic precursor state of multiple myeloma (MM). Recently, MM was redefined to include biomarkers predicting a high risk of progression from SMM, thus necessitating a redefinition of SMM and its risk stratification. We assembled a large cohort of SMM patients meeting the revised IMWG criteria to develop a new risk stratification system. We included 1996 patients, and using stepwise selection and multivariable analysis, we identified three independent factors predicting progression risk at 2 years: serum M-protein >2 g/dL (HR: 2.1), involved to uninvolved free light-chain ratio >20 (HR: 2.7), and marrow plasma cell infiltration >20% (HR: 2.4). This translates into 3 categories with increasing 2-year progression risk: 6% for low risk (38%; no risk factors, HR: 1); 18% for intermediate risk (33%; 1 factor; HR: 3.0), and 44% for high risk (29%; 2-3 factors). Addition of cytogenetic abnormalities (t(4;14), t(14;16), +1q, and/or del13q) allowed separation into 4 groups (low risk with 0, low intermediate risk with 1, intermediate risk with 2, and high risk with >= 3 risk factors) with 6, 23, 46, and 63% risk of progression in 2 years, respectively. The 2/20/20 risk stratification model can be easily implemented to identify high-risk SMM for clinical research and routine practice and will be widely applicable.