Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Blood Cancer J. 2018 Jun 12;8(6):59. doi: 10.1038/s41408-018-0077-4.
In 2014, the International Myeloma Working Group reclassified patients with smoldering multiple myeloma (SMM) and bone marrow-plasma cell percentage (BMPC%) ≥ 60%, or serum free light chain ratio (FLCr) ≥ 100 or >1 focal lesion on magnetic resonance imaging as multiple myeloma (MM). Predictors of progression in patients currently classified as SMM are not known. We identified 421 patients with SMM, diagnosed between 2003 and 2015. The median time to progression (TTP) was 57 months (CI, 45-72). BMPC% > 20% [hazard ratio (HR): 2.28 (CI, 1.63-3.20); p < 0.0001]; M-protein > 2g/dL [HR: 1.56 (CI, 1.11-2.20); p = 0.01], and FLCr > 20 [HR: 2.13 (CI, 1.55-2.93); p < 0.0001] independently predicted shorter TTP in multivariate analysis. Age and immunoparesis were not significant. We stratified patients into three groups: low risk (none of the three risk factors; n = 143); intermediate risk (one of the three risk factors; n = 121); and high risk (≥2 of the three risk factors; n = 153). The median TTP for low-, intermediate-, and high-risk groups were 110, 68, and 29 months, respectively (p < 0.0001). BMPC% > 20%, M-protein > 2 g/dL, and FLCr > 20 at diagnosis can be used to risk stratify patients with SMM. Patients with high-risk SMM need close follow-up and are candidates for clinical trials aiming to prevent progression.
2014 年，国际骨髓瘤工作组将冒烟型多发性骨髓瘤（SMM）患者和骨髓浆细胞百分比（BMPC%）≥60%，或血清游离轻链比（FLCr）≥100 或磁共振成像上有>1 个局灶性病变归类为多发性骨髓瘤（MM）。目前分类为 SMM 的患者的进展预测因素尚不清楚。我们确定了 421 例 SMM 患者，他们于 2003 年至 2015 年间被诊断为 SMM。进展的中位时间（TTP）为 57 个月（CI，45-72）。BMPC%>20%[风险比（HR）：2.28（CI，1.63-3.20）；p<0.0001]；M 蛋白>2g/dL[HR：1.56（CI，1.11-2.20）；p=0.01]和 FLCr>20[HR：2.13（CI，1.55-2.93）；p<0.0001]在多变量分析中独立预测 TTP 较短。年龄和免疫缺陷在统计学上无显著意义。我们将患者分为三组：低危组（无三个危险因素；n=143）；中危组（存在三个危险因素中的一个；n=121）；高危组（存在三个危险因素中的两个或以上；n=153）。低危、中危和高危组的中位 TTP 分别为 110、68 和 29 个月，差异具有统计学意义（p<0.0001）。SMM 患者初诊时存在 BMPC%>20%、M 蛋白>2g/dL 和 FLCr>20，可用于风险分层。高危 SMM 患者需要密切随访，是旨在预防进展的临床试验的候选者。
