The approach to patients with high-risk smoldering multiple myeloma (SMM) varies among clinicians; while some advocate early intervention, others reserve treatment at progression to multiple myeloma (MM). We aimed to describe the myeloma-defining events (MDEs) and clinical presentations leading to MM diagnosis among SMM patients seen at our institution. We included 406 patients diagnosed with SMM between 2013–2022, seen at Mayo Clinic, Rochester, MN. The 2018 Mayo 20/2/20 criteria were used for risk stratification. Median follow-up was 3.9 years. Among high-risk patients who did not receive treatment in the SMM phase (n = 71), 51 progressed by last follow-up; the MDEs included: bone lesions (37%), anemia (35%), hypercalcemia (8%), and renal failure (6%); 24% met MM criteria based on marrow plasmacytosis (≥60%) and/or free light chain ratio (>100); 45% had clinically significant MDEs (hypercalcemia, renal insufficiency, and/or bone lesions). MM diagnosis was made based on surveillance labs/imaging(45%), testing obtained due to provider suspicion for progression (14%), bone pain (20%), and hospitalization/ED presentations due to MM complications/symptoms (4%). The presentation was undocumented in 14%. A high proportion (45%) of patients with high-risk SMM on active surveillance develop end-organ damage at progression. About a quarter of patients who progress to MM are not diagnosed based on routine interval surveillance testing.
针对高危冒烟型多发性骨髓瘤（SMM）患者的治疗策略在临床医生中存在差异：部分主张早期干预，另一部分则选择待进展为多发性骨髓瘤（MM）后再行治疗。本研究旨在描述我院就诊的SMM患者进展至MM诊断时的骨髓瘤定义事件（MDEs）及临床表现。我们纳入了2013至2022年间在明尼苏达州罗切斯特市梅奥诊所确诊的406例SMM患者，采用2018年梅奥20/2/20标准进行风险分层。中位随访时间为3.9年。在SMM阶段未接受治疗的高危患者（n=71）中，51例在末次随访时出现疾病进展；其MDEs包括：骨病变（37%）、贫血（35%）、高钙血症（8%）和肾功能衰竭（6%）；24%患者基于骨髓浆细胞比例（≥60%）和/或游离轻链比值（>100）达到MM诊断标准；45%患者出现具有临床意义的MDEs（高钙血症、肾功能不全和/或骨病变）。MM的诊断依据包括：监测性实验室/影像学检查（45%）、因医生怀疑进展而进行的检测（14%）、骨痛症状（20%）以及因MM并发症/症状导致的住院/急诊就诊（4%）。另有14%病例的诊断依据未记录。在主动监测的高危SMM患者中，高达45%在疾病进展时出现终末器官损伤。约四分之一进展为MM的患者未能通过常规间隔监测检查获得诊断。
Mode of progression in smoldering multiple myeloma: a study of 406 patients
肿瘤(癌症)患者之家