1. Smoldering multiple myeloma: biology, clinical manifestations and management
- Author
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Olivier Decaux, Laura Cailly, Xavier Leleu, Laly Nsiala, Cécile Gruchet, Niels Moya, Stéphanie Guidez, Florence Sabirou, Arthur Bobin, Helene Gardeney, Anthony Levy, Salomon Manier, Cécile Tomowiak, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
- Subjects
Oncology ,Smoldering Multiple Myeloma ,Cancer Research ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Biology ,Asymptomatic ,03 medical and health sciences ,Therapeutic approach ,Risk model ,0302 clinical medicine ,Immune system ,Risk Factors ,Internal medicine ,risk-model ,medicine ,Humans ,Multiple myeloma ,030304 developmental biology ,0303 health sciences ,Hematology ,medicine.disease ,Immune surveillance ,SMM ,3. Good health ,medicine.anatomical_structure ,active MM ,030220 oncology & carcinogenesis ,Disease Progression ,Bone marrow ,medicine.symptom ,Monoclonal protein ,Multiple Myeloma - Abstract
International audience; Smoldering multiple myeloma (SMM) is a heterogeneous group of asymptomatic plasma cell disorder characterized by the presence of monoclonal protein >= 30 g/L and/or 10-60% of bone marrow plasma cells and no evidence of SLiM-CRAB criteria according to the 2014 International Myeloma Working Group (IMWG) recommendations. Once the effort to reclassify SMM with active disease as MM requiring treatment was completed, the need to redefine new high-risk SMM arose. The 20/2/20 and the IMWG risk model with the add-on high-risk cytogenetic abnormalities allow to identify high-risk SMM with 50% risk of progression to MM within 2 years, and therefore might help to propose a better therapeutic approach, either with the goal to << cure >> by profoundly debulk the MM with aggressive therapies, or alternatively to restore the immune surveillance like a << delay >> strategy with immune-based therapies. The debate is still ongoing but clearly challenges the watch-and-wait standard of care.
- Published
- 2021