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WHO Classification of Tumours
Asymptomatic (smoldering) myeloma
Tumours of haematopoietic and lymphoid tissues


Definition

Asymptomatic (smoldering) myeloma is a subtype of plasma cell myeloma .

In asymptomatic plasma cell myeloma, the diagnostic criteria for myeloma are met but no related organ or tissue impairment (end-organ damage) is present (Table 10.05)

Click to access Pubmed
(2003)
Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group.
Br J Haematol 121: 749-57




Click to access Pubmed
Kyle RA, Greipp PR (1980)
Smoldering multiple myeloma.
N Engl J Med 302: 1347-9



. Asymptomatic plasma cell myeloma is similar to MGUS in its lack of clinical manifestations, but is much more likely to progress to symptomatic myeloma
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Dimopoulos MA, Moulopoulos LA, Maniatis A, Alexanian R (2000)
Solitary plasmacytoma of bone and asymptomatic multiple myeloma.
Blood 96: 2037-44




Click to access Pubmed
Kyle RA, Remstein ED, Therneau TM, Dispenzieri A, Kurtin PJ, Hodnefield JM, Larson DR, Plevak MF, Jelinek DF, Fonseca R, Melton LJ, Rajkumar SV (2007)
Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma.
N Engl J Med 356: 2582-90




Click to access Pubmed
Kyle RA, Therneau TM, Rajkumar SV, Offord JR, Larson DR, Plevak MF, Melton LJ (2002)
A long-term study of prognosis in monoclonal gammopathy of undetermined significance.
N Engl J Med 346: 564-9



. Patients with Durie-Salmon stage I disease are included in this category and in some series so are asymptomatic patients with an apparent solitary plasmacytoma but with additional bone abnormalities detected only by MRI
Click to access Pubmed
(2003)
Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group.
Br J Haematol 121: 749-57




Click to access Pubmed
Dimopoulos MA, Moulopoulos LA, Maniatis A, Alexanian R (2000)
Solitary plasmacytoma of bone and asymptomatic multiple myeloma.
Blood 96: 2037-44



. About 8% of patients with myeloma are initially asymptomatic
Click to access Pubmed
Kyle RA, Remstein ED, Therneau TM, Dispenzieri A, Kurtin PJ, Hodnefield JM, Larson DR, Plevak MF, Jelinek DF, Fonseca R, Melton LJ, Rajkumar SV (2007)
Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma.
N Engl J Med 356: 2582-90



. The majority have between 10 and 20% BM plasma cells and the median level of serum M-protein is nearly 30g/L. Normal polyclonal immunoglobulins are reduced in >90% of patients and ~70% have monoclonal light chains in urine
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Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR (2003)
Review of 1027 patients with newly diagnosed multiple myeloma.
Mayo Clin Proc 78: 21-33



. Patients may have stable disease for long periods but the cumulative probability of progression to symptomatic myeloma or amyloidosis is 10% per year for the first 5 years, 3% per year for the next 5 years and approximately 1% for the subsequent 10 years
Click to access Pubmed
Kyle RA, Remstein ED, Therneau TM, Dispenzieri A, Kurtin PJ, Hodnefield JM, Larson DR, Plevak MF, Jelinek DF, Fonseca R, Melton LJ, Rajkumar SV (2007)
Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma.
N Engl J Med 356: 2582-90



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> Related Topics
Definition: Plasma cell neoplasms
Introduction: Classification of lymphoid neoplasms