Plasma cells expression from smoulderingmyeloma to myeloma reveals the importance of the PRC2 complex, cell cycle progression, and the divergent evolutionary pathways within the different molecular subgroups. Sequencing studies have shed some light on the pathogenesis of progression from smouldering multiple myeloma (SMM) and symptomatic multiple myeloma (MM). Given the scarcity of smouldering
Isatuximab and Iberdomide As Immunotherapy for High Risk in SmoulderingMyeloma The study will test a new combination of 3 drugs: Isatuximab (Isa), Iberdomide (Iber) and Dexamethasone (Dex), in patients who have intermediate or high risk smoulderingmyeloma. Smoulderingmyeloma is an early form of myeloma which may progress to active multiple myeloma, but at a slow rate. Patients with smoulderingmyeloma do not usually receive any treatment but will have regular check-ups and observation. Some patients have a diagnosis of smoulderingmyeloma which has a higher risk of progressing to active myeloma. The study will test if the combination of drugs is effective at preventing or delaying the disease progressing into active multiple myeloma. The study will also test if the combination is tolerated
The diagnostic value of SE MRI and DWI of the spine in patients with monoclonal gammopathy of undetermined significance, smoulderingmyeloma and multiple myeloma. To evaluate DWI of the bone marrow in the differentiation of monoclonal gammopathy of undetermined significance (MGUS), smoulderingmyeloma (SMM) and multiple myeloma (MM). The retrospective study includes 64 patients with MGUS, 27
Biology and Genetics of SmoulderingMyeloma Observational clinical trial recruiting SmoulderingMyeloma patients (SMM) or potential SMM patients. Study involves collecting blood and bone marrow samples to determine the features of the tumour genome and BM microenvironment, including immune dysfunction that are key drivers of progression from precursor conditions (MGUS and SMM) to MM. MM
smoulderingmyeloma and primary plasma cell leukaemia) in people aged 16 and over. It aims to improve care for people with myeloma by promoting the most effective tests and treatments for myeloma and its complications. In October 2018 we deleted the recommendations on preventing thrombosis because they have been replaced by the NICE guideline on venous thromboembolism in over 16s. Who to be myeloma. Imaging for people with newly diagnosed myeloma 1.3.6 For people with newly diagnosed myeloma or smoulderingmyeloma who have not had whole-body imaging with 1 of the following, consider whole-body imaging to assess for myeloma-related bone disease and extra-medullary plasmacytomas with one of: • MRI • CT • fluorodeoxyglucose positron emission tomography CT (FDG PET-CT). 1.3.7 For guidance
(Kd 1.43x10-6 mol/L) for insulin. The monoclonal gammopathy was restaged as smoulderingmyeloma not warranting plasma cell directed therapy from a haematological standpoint. Plasma exchange reduced paraprotein levels and improved fasting capillary glucose concentrations. Lenalidomide was used to treat disabling hypoglycaemia, successfully depleting paraprotein and leading to resolution of symptoms.
, ; Weiss et al , ). Smoulderingmyeloma is an intervening phase between MGUS and myeloma but is not a single entity; there is a biological spectrum ranging from a stable state resembling MGUS, which does not progress, to a condition where progression to symptomatic disease is inevitable. One of the defining criteria for multiple myeloma is the unequivocal presence of myeloma bone disease (Kyle & Rajkumar it is difficult to survey by plain X‐ray, e.g. scapulae and sternum. Given the recently revised classification of multiple myeloma, CT scanning is a suitable option for patients with suspected smoulderingmyeloma, but is not necessary in straightforward MGUS patients, unless they have skeletal symptoms. From a practical point of view, CT has the advantage of being quick to perform and allows patients to lie
Conventional band karyotyping at diagnosis. To indicate ploidy staus and presence of del13q. Full karyotyping not required. • MRI may be indicated in special circumstances (i.e., to rule out cord compression, CNS involvement, non-secretory multiple myeloma, smoulderingmyeloma and solitary bone or soft tissue plasmacytoma) • PET scan is not currently indicated for the diagnosis or follow-up of multiple
Platelet hyperactivation in multiple myeloma is also evident in patients with premalignant monoclonal gammopathy of undetermined significance. Thrombotic events are common in patients with multiple myeloma (MM), smoulderingmyeloma (SM) and monoclonal gammopathy of undetermined significance (MGUS). Previous studies have indicated platelet hyperactivation as a feature of thrombotic risk in MM
-malignant stage, which is called monoclonal gammopathy of undetermined significance (MGUS). MGUS progresses to myeloma at a rate of 1% per year.In some patients there is an intermediate asymptomatic but more advanced pre-malignant stage. This is called smouldering (or indolent) myeloma. Smoulderingmyeloma progresses to myeloma at a rate of 10% per year over the first five years following diagnosis, 3 . Treatment is aimed at controlling the disease, prolonging survival and maximising quality of life. Emotional and psychological support for patients, carers and relatives should not be forgotten.Immediate treatment is currently not recommended for patients with smoulderingmyeloma. NICE recommends monitoring people with smoulderingmyeloma every three months for the first five years, and then deciding
. Distinguishing symptomatic myeloma, which typically requires treatment, from precursor lesions such as monoclonal gammopathy of undetermined significance (MGUS) or smoulderingmyeloma can also be difficult.MGUS and smoulderingmyeloma are asymptomatic with no evidence of end organ damage. Monoclonal gammopathy of undetermined significance is defined as a serum paraprotein of <30 g/L with a marrow plasma cell should have all necessary dental work completed prior to commencing bisphosphonates to minimise the risk of ONJ.Smouldering myeloma and MGUSTreatment for those with MGUS and smoulderingmyeloma consists of watchful waiting, with serial monitoring of the paraprotein and frequent assessment for the development of myeloma-related organ or tissue impairment. Australian guidelines suggest monitoring of MGUS
. This can be accomplished by identifying the genetic mechanisms and mutations driving the transition of a normal plasma cell to one with the features of the following disease stages: monoclonal gammopathy of undetermined significance, smoulderingmyeloma, myeloma and plasma cell leukaemia. Although myeloma initiating events are clonal, subsequent driver lesions often occur in a subclone of cells
clinical research focuses on the balance between treatment efficacy and quality of life, the optimum sequencing of treatment options, the question of long-term remission and potential cure by multimodal treatment, the pre-emptive treatment of high-risk smoulderingmyeloma, and the role of maintenance. Upcoming results of ongoing clinical trials, together with a pipeline of promising new treatments, raise
MRI in multiple myeloma: a pictorial review of diagnostic and post-treatment findings Magnetic resonance imaging (MRI) is increasingly being used in the diagnostic work-up of patients with multiple myeloma. Since 2014, MRI findings are included in the new diagnostic criteria proposed by the International Myeloma Working Group. Patients with smoulderingmyeloma presenting with more than one and diffusion weighted imaging sequences, providing additional functional information on bone marrow vascularization and cellularity.This pictorial review provides an overview of the most important imaging findings in patients with monoclonal gammopathy of undetermined significance, smoulderingmyeloma and multiple myeloma, by performing a 'total' MRI investigation with implications for the diagnosis, staging
The genetic architecture of multiple myeloma. Based on the clinical features of myeloma and related malignancies of plasma cells, it has been possible to generate a model system of myeloma progression from a normal plasma cell through smoulderingmyeloma to myeloma and then plasma cell leukaemia. Using this model system we can study at which points the genetic alterations identified through whole
Oxford Pre-cancerous Lymphoproliferative Disorders Study OxPLoreD is an observational cohort study to identify clinical, genomic and immunological predictive markers of progression to malignant disease. Open to individuals diagnosed in the last 3 years with high count MBL, Binet Stage A CLL, Immunoglobulin G/A/M (IgG, IgA, IgM) MGUS, asymptomatic WM not requiring treatment and smoulderingmyeloma not requiring treatment. The purpose of the study is to monitor patients with early stage lymphoproliferative disorders not meeting criteria for treatment, including early stage Chronic Lymphocytic Leukaemia (CLL), Monoclonal B-cell Lymphocytosis (MBL), Monoclonal Gammopathy of Uncertain Significance (MGUS), asymptomatic Waldenstroms Macroglobulinaemia (WM) and SmoulderingMyeloma (SM).Each of these disorders
to evolve commonly from monoclonal gammopathy of undertermined clinical significance (MGUS) which develops to smoulderingmyeloma and finally to symptomatic myeloma (1).Presentation is with anaemia, bone pain, skeletal destruction, pathologic fractures, or Bence Jones proteinuria and increased susceptibility to infection (3).Myeloma is the seventeenth most common cancer in the UK. In 2010, 4672 people ).MyelomaLast reviewed 08/2021Links: * incidence * aetiology * clinical features * investigations * diagnostic criteria for MGUS (Monoclonal Gammopathy of Unknown Significance), asymptomatic myeloma and symptomatic myeloma * differential diagnosis * treatment of multiple myeloma * complications * prognosis of multiple myeloma * smoulderingmyeloma (asymptomatic myeloma) * prevention and early management