Sometimes, routine health exams like blood tests can uncover health issues you didn’t even know you had. That’s often the case with a rare, pre-cancerous condition called smoldering myeloma.
“Abnormalities in routine blood work are the first red flag,” says myeloma specialist Elisabet Manasanch, M.D. Patients will receive additional testing, and if results reveal a certain level of plasma cells in the bone marrow or an increase in abnormal protein in your blood, you may be diagnosed with smoldering myeloma.
“Most patients with smoldering myeloma don’t have symptoms that can be directly attributed to the underlying blood disorder,” says Manasanch.
Abnormal plasma cells can turn into smoldering myeloma
Plasma cells are an important part of our immune system. They live in the bone marrow. Their main role is to produce antibodies to fight infection. Sometimes these cells divide too quickly and produce abnormal cells.
These abnormal cells can turn into multiple myeloma, a cancer of the bone marrow. But sometimes they may cause smoldering myeloma, named for the disease’s likelihood to get worse over time.
“It’s what we call a precursor stage of multiple myeloma,” Manasanch says.
Risk factors for smoldering myeloma aren’t clear
Because it’s rare, it’s not clear what causes certain people to develop smoldering myeloma. The disease is more common in men, Black people and individuals who have been exposed to chemicals, such as Agent Orange and benzene. It is also more common in people who have had family members diagnosed with multiple myeloma.
Manasanch says research is underway to identify a potential genetic link.
“Clinical trials are looking to screen family members of patients with smoldering myeloma to identify early signs of the disease,” Manasanch says.
Smoldering myeloma is different from monoclonal gammopathy of undetermined significance (MGUS)
A condition called monoclonal gammopathy of undetermined significance (MGUS) can also lead to multiple myeloma. Patients with MGUS have a low level of abnormal plasma cells and abnormal protein in their blood.
Since patients with smoldering myeloma have even more abnormal plasma cells, they’re more likely to develop multiple myeloma. But MGUS may not ever progress or require treatment.
“MGUS is more of a chronic condition that can be monitored over time,” Manasanch says.
Smoldering myeloma treatment depend on your risk of complications
Smoldering myeloma is staged into low-, intermediate- and high-risk disease based on how likely you are to develop health-related complications from your myeloma that require treatment.
These complications can include low bone density, which may lead to fractures and bone pain; they can also include anemia, kidney problems, high calcium in your blood, weight loss and fatigue.
“With smoldering myeloma, staging isn’t a gauge of prognosis like staging methods for other types of cancer,” Manasanch says. “It’s about your risk of developing complications due to the underlying myeloma.”
Patients with low-risk disease have a 20% chance of needing treatment for these complications in the five years after diagnosis. Patients with intermediate-risk disease have a 50% chance of needing treatment, and patients with high-risk disease have a 75% to 80% chance of needing treatment.
“Even patients with low-risk smoldering myeloma are at risk of progression,” Manasanch says. “So, it’s important to have regular checkups with your care team even when your risk of progression is low.”
Routine bloodwork will help your care team identify any complications and figure out how to approach them effectively. You may experience other effects or complications that are not related to your underlying smoldering myeloma. Those can be managed with other treatments.
Surveillance is an option for smoldering myeloma
Even though patients with smoldering myeloma may experience complications in the future, they may not need cancer treatment if these complications aren’t caused by the myeloma itself, Manasanch says. Patients often enter a period of surveillance, when their care team will “watch and wait” to decide when to treat.
If complications are caused by myeloma, you may receive a multiple myeloma diagnosis and undergo treatment. This usually involves a combination of high-dose chemotherapy, called melphalan, with stem cell rescue and modern bio-therapies, such as lenalidomide, bortezomib, carfilzomib, daratumumab or radiation therapy.
Clinical trials are helping to slow the progression from smoldering myeloma to multiple myeloma
Through research and clinical trials, experts are exploring new treatment options for smoldering myeloma to reduce the risk of progression.
“For low-risk smoldering myeloma, there are studies investigating treatment with monoclonal antibodies and vaccines,” Manasanch says. There are also clinical trials looking into immune-boosting steroids for patients with high-risk disease.
If you’re newly diagnosed with smoldering myeloma, Manasanch encourages you to consider clinical trials.
“Clinical trials are changing the way we manage smoldering myeloma,” she says. “We’re seeing treatments lead to delayed progression, which is extremely encouraging.”
Some of these trials could lead to approval of certain treatment regimens by the Food and Drug Administration (FDA). This could shape treatment options for future patients.
“The more patients enroll in clinical trials, the sooner patients can benefit from their findings,” Manasanch says.