1
|
Raghunathachar SK, Krishnamurthy KP, Gopalaiah LM, Abhijith D, Prashant A, Parichay SR, Ramesh AM. Navigating the clinical landscape: Update on the diagnostic and prognostic biomarkers in multiple myeloma. Mol Biol Rep 2024; 51:972. [PMID: 39249557 DOI: 10.1007/s11033-024-09892-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/26/2024] [Indexed: 09/10/2024]
Abstract
Multiple myeloma, a complex hematologic malignancy, has devastating consequences for patients, including dramatic bone loss, severe bone pain, and pathological fractures that markedly decrease the quality of life and impact the survival of affected patients. This necessitates a refined understanding of biomarkers for accurate diagnosis and prognosis of such severe malignancy. Therefore, this article comprehensively covers current research, elucidating the diverse spectrum of biomarkers employed in clinical settings. From traditional serum markers to advanced molecular profiling techniques, the review provides a thorough examination of their utility and limitations. Through this scoping review, emphasis is placed on the evolving landscape of personalized medicine, where biomarkers play a pivotal role in tailoring therapeutic strategies. The integration of genomic, proteomic, next generation sequencing and flow cytometric data further enriches the discussion, unravelling the molecular intricacies underlying disease progression. The updated criteria allow for the treatment of people who clearly would benefit from therapy and might live longer if treated before significant organ damage occurs. Navigating through the evolving diagnostic and prognostic paradigms in multiple myeloma, this article equips clinicians and researchers with crucial insights for optimizing patient care and advancing future therapeutic approaches.
Collapse
Affiliation(s)
| | - Kiran Pura Krishnamurthy
- Department of Oncology, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru, 570015, India
| | | | - D Abhijith
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru, 570015, India
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru, 570015, India
| | | | - Arpitha Maraliga Ramesh
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru, 570015, India.
| |
Collapse
|
2
|
Abdallah NH, Lakshman A, Kumar SK, Cook J, Binder M, Kapoor P, Dispenzieri A, Gertz MA, Lacy MQ, Hayman SR, Buadi FK, Dingli D, Lin Y, Kourelis T, Warsame R, Bergsagel L, Rajkumar SV. Mode of progression in smoldering multiple myeloma: a study of 406 patients. Blood Cancer J 2024; 14:9. [PMID: 38228628 PMCID: PMC10791688 DOI: 10.1038/s41408-024-00980-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/18/2024] Open
Abstract
The approach to patients with high-risk smoldering multiple myeloma (SMM) varies among clinicians; while some advocate early intervention, others reserve treatment at progression to multiple myeloma (MM). We aimed to describe the myeloma-defining events (MDEs) and clinical presentations leading to MM diagnosis among SMM patients seen at our institution. We included 406 patients diagnosed with SMM between 2013-2022, seen at Mayo Clinic, Rochester, MN. The 2018 Mayo 20/2/20 criteria were used for risk stratification. Median follow-up was 3.9 years. Among high-risk patients who did not receive treatment in the SMM phase (n = 71), 51 progressed by last follow-up; the MDEs included: bone lesions (37%), anemia (35%), hypercalcemia (8%), and renal failure (6%); 24% met MM criteria based on marrow plasmacytosis (≥60%) and/or free light chain ratio (>100); 45% had clinically significant MDEs (hypercalcemia, renal insufficiency, and/or bone lesions). MM diagnosis was made based on surveillance labs/imaging(45%), testing obtained due to provider suspicion for progression (14%), bone pain (20%), and hospitalization/ED presentations due to MM complications/symptoms (4%). The presentation was undocumented in 14%. A high proportion (45%) of patients with high-risk SMM on active surveillance develop end-organ damage at progression. About a quarter of patients who progress to MM are not diagnosed based on routine interval surveillance testing.
Collapse
Affiliation(s)
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Joselle Cook
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | |
Collapse
|
3
|
Rajkumar S, Abdallah N, Lakshman A, Kumar S, Cook J, Binder M, Kapoor P, Dispenzieri A, Gertz M, Lacy M, Hayman S, Buadi F, Dingli D, Lin Y, Kourelis T, Warsame R, Bergsagel PL. Mode of Progression in Smoldering Multiple Myeloma: A study of 406 patients. RESEARCH SQUARE 2023:rs.3.rs-3378634. [PMID: 37961238 PMCID: PMC10635305 DOI: 10.21203/rs.3.rs-3378634/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The approach to patients with high-risk smoldering multiple myeloma (SMM) varies among clinicians; while some advocate early intervention, others reserve treatment at progression to multiple myeloma (MM). We aimed to describe the myeloma-defining events (MDEs) and clinical presentations leading to MM diagnosis among SMM patients seen at our institution. We included 406 patients diagnosed with SMM between 2013-2022, seen at Mayo Clinic, Rochester, MN. The 2018 Mayo 20/2/20 criteria were used for risk stratification. Median follow-up was 3.9 years. Among high-risk patients who did not receive treatment in the SMM phase (n=71), 51 progressed by last follow-up; the MDEs included: bone lesions(37%), anemia(35%), hypercalcemia(8%), and renal failure(6%); 24% met MM criteria based on marrow plasmacytosis (≥60%) and/or free light chain ratio (>100); 45% had clinically significant MDEs (hypercalcemia, renal insufficiency, and/or bone lesions). MM diagnosis was made based on surveillance labs/imaging(45%), testing obtained due to provider suspicion for progression(14%), bone pain(20%), and hospitalization/ED presentations due to MM complications/symptoms(4%). The presentation was undocumented in 14%. A high proportion (45%) of patients with high-risk SMM on active surveillance develop end-organ damage at progression. About a quarter of patients who progress to MM are not diagnosed based on routine interval surveillance testing.
Collapse
|
4
|
Thorsteinsdottir S. The consultant's guide to smoldering multiple myeloma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:551-559. [PMID: 36485144 PMCID: PMC9821526 DOI: 10.1182/hematology.2022000355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic precursor condition to multiple myeloma (MM). The prevalence of SMM is 0.5% in persons over 40 years old; it is higher in men than women and increases with age. When SMM is diagnosed, a thorough diagnostic workup is necessary to exclude myeloma-defining events and stratify patients according to risk of progression to MM. While close monitoring for progression remains the best management for most patients with SMM, in this article, we discuss if treatment initiation before myeloma-defining events occur might be relevant in selected high-risk cases. Two randomized clinical trials have shown a clinical benefit of initiating treatment at the SMM stage, whereof 1 showed an overall survival benefit for those receiving treatment. We discuss various risk stratification models in SMM, important treatment trials, and ongoing trials. Finally, we present how to approach the clinical management of patients with SMM.
Collapse
Affiliation(s)
- Sigrun Thorsteinsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|