_id

683a1615c782e11e38d1b1a5

id

3929

title

Asymptomatic Myeloma Prognosis

full_title

Asymptomatic Myeloma Prognosis

short_title

Asymptomatic Myeloma Prognosis

med_description

Predicts risk of progression of asymptomatic (smoldering) multiple myeloma to active myeloma or amyloidosis.

short_description

Predicts risk of progression to active myeloma or amyloidosis.

slug

asymptomatic-myeloma-prognosis

description

The Asymptomatic Myeloma Prognosis predicts risk of progression of asymptomatic (smoldering) multiple myeloma to active myeloma or amyloidosis.

keywords

smm, smoldering myeloma

complaint

[ "Extremity Pain", "Neck Pain", "Pain", "Weakness" ]

formula

High risk BM plasmacytosis ≥10% AND Serum monoclonal protein ≥3 g/dL Intermediate risk BM plasmacytosis ≥10% AND Serum monoclonal protein <3 g/dL Low risk BM plasmacytosis <10% AND Serum monoclonal protein ≥3 g/dL

evidence

The Mayo Clinic analyzed 3,549 patients with myeloma referred between 1970 and 1995. 276 (8%) fulfilled criteria for smoldering multiple myeloma (SMM).

Patients’ bone marrows, labs and longitudinal records were reviewed. The end point was progression to active myeloma or amyloidosis requiring therapy.

Pertinent outcomes:

1. 85% of SMM patients died, median follow up 11.6 years.
2. 57% developed active MM, with median survival after of 3.4 years.
3. Cumulative probability of progression 51% at 5 years, 66% at 10 years, and 73% at 15 years.
4. Risk of progression was 10% per year for the first 5 years, 3% per year for next 5 years, then 1% per year for the next 10 years.

measurements

[]

information

refrences

{ "Clinical Practice Guidelines": [ { "href": "", "text": "" } ], "Manufacturer Website": [ { "href": "", "text": "" } ], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/17582068", "text": "Kyle RA, Remstein ED, Therneau TM, Dispenzieri A, Kurtin PJ, Hodnefield JM, Larson DR, Plevak MF, Jelinek DF, Fonseca R, Melton LJ 3rd, Rajkumar SV. Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma. N Engl J Med. 2007 Jun 21;356(25):2582-90. PMID:17582068." } ], "Other References": [ { "href": "", "text": "" } ], "Outcomes": [ { "href": "", "text": "" } ], "Validation": [ { "href": "https://www.bloodjournal.org/content/126/23/4251", "text": "Kastritis E, Terpos E, et al. Validation of the Novel Criteria for the Definition of Symptomatic Myeloma: A Single Center Experience in 216 Patients with the Previous Diagnosis of Asymptomatic Disease. Blood 2015 126:4251" } ], "Validations": [] }

pearls

The Asymptomatic Myeloma Prognosis calculator classifies smoldering multiple myeloma (MM) patients into 3 prognostic groups, with differing risks of progression to active MM or amyloidosis.

The criteria developed by the International Myeloma Working Group for diagnosis of smoldering multiple myeloma (SMM, or asymptomatic MM) are:

1. Serum monoclonal protein ≥3 g/dL OR
2. Plasma cells in bone marrow (BM) ≥ 10% AND
3. No evidence of end-organ damage (no anemia, bone lesions, renal dysfunction, hypercalcemia, or recurrent bacterial infections)

Prognosis and risk for progression to MM are quite variable.

Overall progression risk was 10%/year for the first five years, 3%/yr for the next five years, then 1%/year for the next ten years. Cumulative risk for progression was 73% at 15 years.

usecase

Newly diagnosed multiple myeloma (MM) patients meeting International Myeloma Working Group criteria for smoldering or asymptomatic MM (see Pearls/Pitfalls for criteria).

reasons

Provides prognostic information for patients. Suggests patients who may need closer follow up. Allows for stratification of patients on clinical trials potentially evaluating newer, targeted myeloma therapies. Does not require FISH studies, cytogenetic, or MRI bone studies, which may add further discrimination but are not widely available; hence, generalizability is preserved in settings with limited availability of these studies.

next_advice

Patients with smoldering or asymptomatic MM are currently observed. However, clinical trials should be sought for appropriate patients given the rapid progress in development of novel active agents.

next_actions

next_management

diseases

[ "Cancer", "Hematologic Malignancy", "Multiple Myeloma" ]

input_schema

[ { "conditionality": "", "default": null, "label_en": "Bone marrow plasmacytosis", "md_calc_info_concept": null, "name": "bmp", "option_fhir_rules": null, "optional": false, "options": [ { "label": "≥10%", "value": 0 }, { "label": "<10%", "value": 1 } ], "show_points": false, "tips_en": "Average % from bone marrow aspirate and core biopsy", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "Serum monoclonal protein, g/dL", "md_calc_info_concept": null, "name": "smp", "option_fhir_rules": null, "optional": false, "options": [ { "label": "≥3", "value": 0 }, { "label": "<3", "value": 1 } ], "show_points": false, "tips_en": "On serum protein electrophoresis", "type": "toggle" } ]

instructions

published

2022-04-21T20:29:26.161Z

purpose

[ "Prognosis" ]

search_terms

[ "mm", "multiple myeloma", "myeloma", "smoldering myeloma", "asymptomatic myeloma", "prognosis" ]

seo

{ "keywords_en": "smm, smoldering myeloma", "meta_description_en": "The Asymptomatic Myeloma Prognosis predicts risk of progression of asymptomatic (smoldering) multiple myeloma to active myeloma or amyloidosis." }

specialty

[ "Hematology and Oncology" ]

departments

[ "Hematologic", "Oncologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 3842, "short_title_en": "Revised Myeloma ISS", "slug": "revised-multiple-myeloma-international-staging-system-r-iss" }, { "calcId": 10498, "short_title_en": "IMPEDE-VTE", "slug": "impede-vte" }, { "calcId": 10232, "short_title_en": "Multiple Myeloma Response Criteria", "slug": "multiple-myeloma-response-criteria" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "hematology", "oncology" ]

cleaned_use

[ "Newly diagnosed multiple myeloma (MM) patients meeting International Myeloma Working Group criteria for smoldering or asymptomatic MM (seePearls/Pitfallsfor criteria)." ]

pub

false