Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Instituto de Biología Molecular y Celular del Cáncer, Universidad de Salamanca-Consejo Superior de Investigaciones Científicas, Salamanca, Spain,
Curr Hematol Malig Rep. 2013 Dec;8(4):270-6. doi: 10.1007/s11899-013-0174-1.
Smoldering multiple myeloma (SMM) is an asymptomatic plasma cell disorder characterized by the presence of one or both features of serum M-protein ≥ 30 g/L and bone marrow plasma cell infiltration ≥ 10 %. However, myeloma-related symptomatology is absent from this condition. The risk of progression to active MM is not uniform, and several markers are useful for identifying SMM patients at high risk of progression to active MM. These include the size of the M-protein and the infiltration in the bone marrow, the serum-free light-chain ratio, the presence of immunoparesis and percentage of plasma cell with aberrant phenotype by flow cytometry, or the presence of focal lesions in magnetic resonance imaging. Overall, the presence of these factors identifies patients who have a 50 % probability of progression at 2 years, and the forthcoming challenge will be to identify ultra-high-risk patients who have an 80 % risk of progression at 2 years. The current standard of care is not to treat until progression to symptomatic disease occurs. Several trials of melphalan, thalidomide and bisphosphonates have been conducted in the overall SMM patient population to examine the delay in time to progression (TTP) to symptomatic disease, but these have shown no significant benefit. However, a randomized trial that focused on high-risk SMM patients allocated to receive early treatment with lenalidomide plus dexamethasone versus observation did report a significant benefit with respect to TTP and overall survival. In summary, high-risk SMM patients should be targetted for early treatment, and more so efforts should be made to identify the ultra-high-risk subgroup within the high-risk SMM patient population which may be considered as early MM and thereby candidates for receiving therapy before they develop myeloma-related symptomatology.
冒烟型多发性骨髓瘤（SMM）是一种无症状浆细胞疾病，其特征为血清 M 蛋白≥30g/L 和骨髓浆细胞浸润≥10%。然而，这种情况下没有骨髓瘤相关的症状。进展为活动性 MM 的风险并不均匀，有几个标志物可用于识别有进展为活动性 MM 高风险的 SMM 患者。这些标志物包括 M 蛋白和骨髓中浆细胞浸润的大小、血清游离轻链比值、免疫缺陷的存在、流式细胞术检测到的浆细胞异常表型的百分比，或磁共振成像中的局灶性病变。总的来说，这些因素的存在确定了在 2 年内有 50%进展概率的患者，而未来的挑战将是识别出在 2 年内有 80%进展概率的超高危患者。目前的治疗标准是在出现症状性疾病之前不进行治疗。已经在总体 SMM 患者人群中进行了几种关于马法兰、沙利度胺和双膦酸盐的临床试验，以检查向症状性疾病进展的时间（TTP）延迟，但这些试验均未显示出显著获益。然而，一项针对高危 SMM 患者的随机试验，将患者分为接受来那度胺联合地塞米松早期治疗与观察，结果显示 TTP 和总生存均有显著获益。总之，高危 SMM 患者应进行早期治疗，应更努力地识别高危 SMM 患者人群中的超高危亚组，这些患者可能被视为早期 MM，并因此成为在出现骨髓瘤相关症状之前接受治疗的候选者。
