Smoldering, or asymptomatic, myeloma is a precursor to multiple myeloma. Across all smoldering myeloma patients, the risk of progression from smoldering to symptomatic disease is around 10 percent during each of the first five years after diagnosis. Although smoldering myeloma patients are at a higher risk of developing symptomatic myeloma the current standard of care is the so-called “watch and wait” approach.
German study that showed that focal lesions found by whole-body MRI scans identify smoldering myeloma patients at high risk for disease progression. The Greek study, however, used MRI scans of the spine, rather than whole-body MRI scanning, to identify focal lesions. According to the Greek researchers, MRIs of the spine are much more widely available, less time consuming, less expensive, and typically more comfortable for patients than whole-body MRI scanning.
The Greek researchers found that the smoldering myeloma patients who had more than one focal lesion in the spine progressed to symptomatic multiple myeloma within a median of 15 months, compared to a median of more than five years for smoldering myeloma patients with no focal lesions in their spines. Among the patients with more than one focal lesion in their spine, 85 percent progressed to multiple myeloma within three years, compared to 22 percent for patients with no focal lesions in the spine.
Based on their findings, the Greek researchers conclude that MRI of the spine should be the imaging method of choice for the identification of patients with smoldering myeloma who are at high risk for progression to symptomatic disease.
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