Asymptomatic Myeloma Prognosis

Serum M-protein ≥3 g/dL

Bone marrow plasma cells ≥10%

Free light chain ratio ≥8 or ≤0.125

≥1 focal lesion on MRI

Score:–

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Predicts risk of progression of asymptomatic (smoldering) multiple myeloma to active myeloma or amyloidosis.

Why Use

Provides prognostic information for patients. Suggests patients who may need closer follow up. Allows for stratification of patients on clinical trials potentially evaluating newer, targeted myeloma therapies. Does not require FISH studies, cytogenetic, or MRI bone studies, which may add further discrimination but are not widely available; hence, generalizability is preserved in settings with limited availability of these studies.

When to Use

Newly diagnosed multiple myeloma (MM) patients meeting International Myeloma Working Group criteria for smoldering or asymptomatic MM (see Pearls/Pitfalls for criteria).

Formula

High risk BM plasmacytosis ≥10% AND Serum monoclonal protein ≥3 g/dL Intermediate risk BM plasmacytosis ≥10% AND Serum monoclonal protein <3 g/dL Low risk BM plasmacytosis <10% AND Serum monoclonal protein ≥3 g/dL

Pearls / Pitfalls

The Asymptomatic Myeloma Prognosis calculator classifies smoldering multiple myeloma (MM) patients into 3 prognostic groups, with differing risks of progression to active MM or amyloidosis. The criteria developed by the International Myeloma Working Group for diagnosis of smoldering multiple myeloma (SMM, or asymptomatic MM) are: Serum monoclonal protein ≥3 g/dL OR Plasma cells in bone marrow (BM) ≥ 10% AND No evidence of end-organ damage (no anemia, bone lesions, renal dysfunction, hypercalcemia, or recurrent bacterial infections) Prognosis and risk for progression to MM are quite variable. Overall progression risk was 10%/year for the first five years, 3%/yr for the next five years, then 1%/year for the next ten years. Cumulative risk for progression was 73% at 15 years.

Advice

Patients with smoldering or asymptomatic MM are currently observed. However, clinical trials should be sought for appropriate patients given the rapid progress in development of novel active agents.

More Information

Risk of progression Median time to progression At 5 years At 10 years At 15 years High risk 69% 77% 87% 27 months (~2 years) Intermediate risk 43% 64% 70% 93 months (~8 years) Low risk 15% 33% 39% 228 months (~19 years)