Carolinas HealthCare System

Levine Cancer Institute
How Long Can We Let the Myeloma Smolder?

Read Dr. Usmani's full editorial.

Saad Usmani, MD, FACP, Director of the Plasma Cell Disorders program and director of clinical research in hematologic malignancies at Levine Cancer Institute, had an editorial published in Informa HealthCare, that discusses the implications of current research underway for asymptomatic multiple myeloma.

Dr. Usmani’s review titled, “How long can we let the myeloma smolder?” evaluates a key study published in the New England Journal of Medicine-- “Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma,” (Mateos MV, Hernandez MT, Giraldo P, et al.)

Included in Dr. Usmani’s ediorital are the following key takeaways:

  • Smoldering, or asymptomatic multiple myeloma, can also be described as a state of "limbo" where a patient does not demonstrate any symptoms of multiple myeloma, and is being observed. Recently, there has been an increase in clinical investigations underway that test whether early intervention, as opposed to "watchful waiting" will improve survival outcomes in patients with asymptomatic multiple myeloma.
  • While the trial reports improved survival outcomes in "high-risk" multiple myeloma patients through use of the drug, lenalidomide, there are several limitations to the study, including a small sample size and patient selectiveness.
  • There is a need for a better understanding of how to treat patients with high-risk, smoldering multiple myeloma. This remains a challenge for practicing hematologic-oncologists, and we can expect to see more research and trials underway surrounding this topic in 2014.
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