TY - JOUR
T1 - International Myeloma Working Group risk stratification model for smoldering multiple myeloma (SMM)
AU - Mateos, María Victoria
AU - Kumar, Shaji
AU - Dimopoulos, Meletios A.
AU - González-Calle, Verónica
AU - Kastritis, Efstathios
AU - Hajek, Roman
AU - De Larrea, Carlos Fernández
AU - Morgan, Gareth J.
AU - Merlini, Giampaolo
AU - Goldschmidt, Hartmut
AU - Geraldes, Catarina
AU - Gozzetti, Alessandro
AU - Kyriakou, Charalampia
AU - Garderet, Laurent
AU - Hansson, Markus
AU - Zamagni, Elena
AU - Fantl, Dorotea
AU - Leleu, Xavier
AU - Kim, Byung Su
AU - Esteves, Graça
AU - Ludwig, Heinz
AU - Usmani, Saad
AU - Min, Chang Ki
AU - Qi, Ming
AU - Ukropec, Jon
AU - Weiss, Brendan M.
AU - Rajkumar, S. Vincent
AU - Durie, Brian G.M.
AU - San-Miguel, Jesús
PY - 2020
Y1 - 2020
N2 - Smoldering multiple myeloma (SMM) is an asymptomatic precursor state of multiple myeloma (MM). Recently, MM was redefined to include biomarkers predicting a high risk of progression from SMM, thus necessitating a redefinition of SMM and its risk stratification. We assembled a large cohort of SMM patients meeting the revised IMWG criteria to develop a new risk stratification system. We included 1996 patients, and using stepwise selection and multivariable analysis, we identified three independent factors predicting progression risk at 2 years: serum M-protein >2 g/dL (HR: 2.1), involved to uninvolved free light-chain ratio >20 (HR: 2.7), and marrow plasma cell infiltration >20% (HR: 2.4). This translates into 3 categories with increasing 2-year progression risk: 6% for low risk (38%; no risk factors, HR: 1); 18% for intermediate risk (33%; 1 factor; HR: 3.0), and 44% for high risk (29%; 2–3 factors). Addition of cytogenetic abnormalities (t(4;14), t(14;16), +1q, and/or del13q) allowed separation into 4 groups (low risk with 0, low intermediate risk with 1, intermediate risk with 2, and high risk with ≥3 risk factors) with 6, 23, 46, and 63% risk of progression in 2 years, respectively. The 2/20/20 risk stratification model can be easily implemented to identify high-risk SMM for clinical research and routine practice and will be widely applicable.
AB - Smoldering multiple myeloma (SMM) is an asymptomatic precursor state of multiple myeloma (MM). Recently, MM was redefined to include biomarkers predicting a high risk of progression from SMM, thus necessitating a redefinition of SMM and its risk stratification. We assembled a large cohort of SMM patients meeting the revised IMWG criteria to develop a new risk stratification system. We included 1996 patients, and using stepwise selection and multivariable analysis, we identified three independent factors predicting progression risk at 2 years: serum M-protein >2 g/dL (HR: 2.1), involved to uninvolved free light-chain ratio >20 (HR: 2.7), and marrow plasma cell infiltration >20% (HR: 2.4). This translates into 3 categories with increasing 2-year progression risk: 6% for low risk (38%; no risk factors, HR: 1); 18% for intermediate risk (33%; 1 factor; HR: 3.0), and 44% for high risk (29%; 2–3 factors). Addition of cytogenetic abnormalities (t(4;14), t(14;16), +1q, and/or del13q) allowed separation into 4 groups (low risk with 0, low intermediate risk with 1, intermediate risk with 2, and high risk with ≥3 risk factors) with 6, 23, 46, and 63% risk of progression in 2 years, respectively. The 2/20/20 risk stratification model can be easily implemented to identify high-risk SMM for clinical research and routine practice and will be widely applicable.
U2 - 10.1038/s41408-020-00366-3
DO - 10.1038/s41408-020-00366-3
M3 - Article
C2 - 33067414
AN - SCOPUS:85092644198
SN - 2044-5385
VL - 10
JO - Blood Cancer Journal
JF - Blood Cancer Journal
IS - 10
M1 - 102
ER -