Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Department of Hematology and Medical Oncology, Emory University School of Medicine Atlanta, Atlanta, GA, USA.
Blood Cancer J. 2022 Sep 5;12(9):129. doi: 10.1038/s41408-022-00719-0.
Smoldering multiple myeloma (SMM) is an asymptomatic condition that occupies a space between monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) along the spectrum of clonal plasma cell proliferative disorders. It is not a biologic intermediate stage between MGUS and MM, but rather represents a heterogeneous clinically defined condition in which some patients (approximately two-thirds) have MGUS (pre-malignancy), and some (approximately one-third) have MM (biologic malignancy). Unfortunately, no single pathologic or molecular feature can reliably distinguish these two groups of patients. For purposes of practice and clinical trials, specific risk factors are used to identify patients with SMM in whom malignant transformation has already likely occurred (high risk SMM). Patients with newly diagnosed high risk SMM should be offered therapy with lenalidomide or lenalidomide plus dexamethasone (Rd) for 2 years, or enrollment in clinical trials. Patients with low risk SMM should be observed without therapy every 3-4 months.
冒烟型多发性骨髓瘤（SMM）是一种无症状的疾病，沿着单克隆浆细胞增殖性疾病谱系，处于意义未明的单克隆丙种球蛋白血症（MGUS）和多发性骨髓瘤（MM）之间。它不是 MGUS 和 MM 之间的生物学中间阶段，而是代表一种异质性的临床定义的疾病状态，其中一些患者（约三分之二）有 MGUS（前期恶性肿瘤），而一些患者（约三分之一）有 MM（生物学恶性肿瘤）。不幸的是，没有单一的病理或分子特征可以可靠地区分这两组患者。为了实践和临床试验的目的，使用特定的危险因素来识别已经可能发生恶性转化的 SMM 患者（高危 SMM）。新诊断的高危 SMM 患者应接受 lenalidomide 或 lenalidomide 加地塞米松（Rd）治疗 2 年，或参加临床试验。低危 SMM 患者应每 3-4 个月观察一次，无需治疗。
