Patel Roshani, Hill Elizabeth, Dhodapkar Madhav
Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Semin Hematol. 2025 Feb;62(1):3-10. doi: 10.1053/j.seminhematol.2024.10.002. Epub 2024 Oct 18.
Smoldering multiple myeloma (SMM) was first described over 40 years ago yet much is still unknown including which patients will ultimately progress to symptomatic multiple myeloma (MM). The genetics of the premalignant clone and the immune microenvironment in which it exists is now well understood to both play a role in disease progression. However, the clinical risk models available to help identify patients at most risk of progression still rely primarily on data reflecting volume of disease rather than underlying biology. While it is of upmost importance to accurately diagnose patients with SMM to avoid over or under treatment, efforts are ongoing to tease out if early intervention is indeed warranted for a subgroup of patients with SMM. This article will review the history and biology of SMM, discuss the utility of existing risk models, and examine the efforts to date which have challenged standard management.
冒烟型多发性骨髓瘤（SMM）早在40多年前就有描述，但仍有许多未知之处，包括哪些患者最终会进展为症状性多发性骨髓瘤（MM）。现在已经清楚地了解到，癌前克隆的遗传学及其所处的免疫微环境在疾病进展中都发挥着作用。然而，现有的用于帮助识别进展风险最高的患者的临床风险模型仍然主要依赖反映疾病负荷的数据，而非潜在生物学特性。虽然准确诊断SMM患者以避免过度或治疗不足至关重要，但目前正在努力弄清楚对于一部分SMM患者是否确实有必要进行早期干预。本文将回顾SMM的历史和生物学特性，讨论现有风险模型的实用性，并审视迄今为止对标准治疗提出挑战的相关研究。
