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Original Article

Prognostic factors associated with progression of smoldering multiple myeloma to symptomatic form†‡

  1. Angela Rago MD1,
  2. Sara Grammatico MD2,
  3. Tommaso Za MD11,
  4. Anna Levi MD2,
  5. Sergio Mecarocci MD1,
  6. Agostina Siniscalchi MD3,
  7. Luca De Rosa MD4,
  8. Stefano Felici MD5,
  9. Velia Bongarzoni MD6,
  10. Anna Lina Piccioni MD7,
  11. Giacinto La Verde MD8,
  12. Francesco Pisani MD9,
  13. Luca Franceschini MD3,
  14. Anna Lisa Paviglianiti MD10,
  15. Tommaso Caravita MD3,
  16. Maria Teresa Petrucci MD2,
  17. Valerio De Stefano MD11,
  18. Giuseppe Cimino MD1,§,*,
  19. on behalf of the Multiple Myeloma GIMEMA-Latium Region Working Group1

Article first published online: 11 JUL 2012

DOI: 10.1002/cncr.27657

Issue

Cancer

Cancer

Volume 118, Issue 22, pages 5544–5549, 15 November 2012

Additional Information

How to Cite

Rago, A., Grammatico, S., Za, T., Levi, A., Mecarocci, S., Siniscalchi, A., De Rosa, L., Felici, S., Bongarzoni, V., Piccioni, A. L., La Verde, G., Pisani, F., Franceschini, L., Paviglianiti, A. L., Caravita, T., Petrucci, M. T., De Stefano, V., Cimino, G. and on behalf of the Multiple Myeloma GIMEMA-Latium Region Working Group (2012), Prognostic factors associated with progression of smoldering multiple myeloma to symptomatic form. Cancer, 118: 5544–5549. doi: 10.1002/cncr.27657

Author Information

  1. 1

    Department of Cellular Biotechnologies and Hematology, “Sapienza” University Polo Pontino, Rome, Italy

  2. 2

    Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Italy Dept. of Hematology, University “Tor Vergata”, S. Eugenio Hospital, Rome

  3. 3

    Department of Hematology, University “Tor Vergata”, S. Eugenio Hospital, Rome, Italy

  4. 4

    Department of Hematology, S. Camillo Hospital, Rome, Italy

  5. 5

    Department of Hematology, Nuovo Regina Margherita Hospital, Rome, Italy

  6. 6

    Department of Hematology, S. Giovanni-Addolorata Hospital, Rome, Italy

  7. 7

    Department of Hematology, S. Pertini Hospital, Rome, Italy

  8. 8

    Department of Hematology, S. Andrea Hospital, “La Sapienza” University of Rome, Rome, Italy

  9. 9

    Department of Hematology, Regina Elena National Cancer Institute, Rome, Italy

  10. 10

    Department of Hematology, University “Campus BioMedico,” Rome, Italy

  11. 11

    Department of Hematology, Catholic University, Rome

  1. §

    Fax: (011) 39-0773-6556248

*Division of Hematology, Department of Cellular Biotechnology and Hematology, University “La Sapienza,” Polo Pontino, Ospedale S.M. Goretti, Via Canova snc; 40100 Latina, Italy

  1. †

    We are grateful to professor Giovanni Codacci Pisanelli for his critical review of the manuscript.

  2. ‡

    In addition to the authors, the following investigators (listed in alphabetic order) participated in the study: A. Andriani, MD, Hematology, Nuovo Regina Margherita Hospital (Rome); L. Annino, MD, Hematology, S. Giovanni Addolorata Hospital (Rome); G. Avvisati, MD, PhD, Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy Unit, University “Campus Bio-Medico” (Rome); A. Bagnato, MD, Hematology, Sandro Pertini Hospital (Rome); m. Cantonetti is Hematology Unit , Tor Vergata, Rome; p De Fabritis IS Hematology Unit, S. Eugenio Hospital Rome; I. Majolino, MD, Hematology Unit, S. Camillo Hospital (Rome); B. Monarca, MD, Hematology, S. Andrea Hospital (Rome); C. Petti, MD, Department of Hematology, Regina Elena National Cancer Institute (Rome).

  3. §

    Fax: (011) 39-0773-6556248

Publication History

  1. Issue published online: 30 OCT 2012
  2. Article first published online: 11 JUL 2012
  3. Manuscript Accepted: 16 APR 2012
  4. Manuscript Revised: 5 APR 2012
  5. Manuscript Received: 16 FEB 2012
Corrected by:

Erratum: Erratum

Vol. 119, Issue 6, 1289, Article first published online: 26 NOV 2012

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Keywords:

  • smoldering multiple myeloma;
  • bone marrow plasma cells;
  • symptomatic multiple myeloma;
  • bone marrow aspirate;
  • bone marrow biopsy

Abstract

BACKGROUND:

Smoldering multiple myeloma (SMM) presents a high risk of progression to symptomatic MM (sy-MM). Herein, we analyzed some predictors of development of sy-MM. In 144 patients with SMM, we also compared the risk of progression predicted by bone marrow plasma cell (BMPC) involvement on the bone marrow biopsy (BMB) versus bone marrow aspirates (BMA).

METHODS:

From January 1980 to July 2010, 397 patients with SMM observed in 12 centers of the Multiple Myeloma GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto) Latium Working Group have been analyzed. At progression to sy-MM, the severity of clinical presentation was graded according to the need of intensive supportive care.

RESULTS:

After a median follow-up of 135 months, the cumulative incidence of progression rates to sy-MM were 45%, 55%, and 75% at 10, 15, and 20 years, respectively. Hemoglobin ≤12.5 g/dL, monoclonal component ≥2.5 g/dL, and BMPC ≥60% were the only parameters negatively affecting the cumulative incidence of progression. In particular, 10 of 397 (2.5%) patients with BMPC ≥60% had a 5.6-fold increased risk of fast progression (within 2 years), which occurred with severe clinical manifestations in 62% of cases. BMB was more sensitive for the detection of BMPC involvement, even though BMA was a more reliable indicator of a rapid progression to sy-MM.

CONCLUSIONS:

The highest risk of rapid evolution to sy-MM and the severity of clinical manifestation at the progression suggest that SMM patients with a BMPC ≥60% should be treated soon after diagnosis. Moreover, BMPC is a more reliable index for progression to sy-MM if assessed by BMA. Cancer 2012. © 2012 American Cancer Society.

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