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Smouldering Multiple Myeloma

Multiple Myeloma

Multiple Myeloma
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Smouldering Multiple Myeloma

Smouldering multiple myeloma is an early precursor of active multiple myeloma (see here for more information about multiple myeloma). Abnormal cells can be detected in the bone marrow or abnormal proteins can be detected in the blood or urine, but patients tend not to show signs or symptoms typically associated with active multiple myeloma, such as bone pain, bone fractures, kidney problems, or anaemia. As abnormal plasma cells are present, organ damage may begin and progress asymptomatically.

Smouldering multiple myeloma is more common in men than in women.

Smouldering multiple myeloma is estimated to affect 0.5% of people over 40 years of age.

This prevalence of smouldering multiple myeloma is estimated to rise to 1.6% in individuals 80 years or older.

Diagnosis and tests

Because smouldering multiple myeloma is asymptomatic and lacks any obvious signs or symptoms, most people will have had it for some time before a diagnosis.

Smouldering multiple myeloma is usually detected incidentally, when people undergo routine testing for other symptoms and results show elevated levels of protein in their blood or urine. Abnormal cells may also be detected in the bone marrow via biopsy.

There are a few ways to test for smouldering multiple myeloma, and it may be diagnosed through one or a combination of the following:

Blood tests to diagnose smouldering multiple myeloma could include serum protein electrophoresis, complete blood count or tests to measure serum calcium and creatinine levels.

A doctor may need to collect urine over a 24-hour period at time of diagnosis and again at different time points as a follow-up.

A doctor will use a needle to collect some of the spongy tissue in the middle of a person’s bone. The lab will check to see if there are abnormal cells in the bone marrow.

This series of X-rays takes a record of all the bones in your body, which can help a doctor spot anything abnormal.

A doctor may also take an MRI scan of the spine and pelvis to look for any lesions or damage. MRI works better than X-rays to pick up certain signs of bone damage that may be getting worse.

Smouldering multiple myeloma is variable and each person is different. A doctor may talk about whether someone has a low, intermediate or high risk of progression to active multiple myeloma within two years.9 The level of risk is calculated based on several pre-defined criteria, and some patients diagnosed may be defined as being at a high-risk of progression to multiple myeloma, while others may be defined as having a low or intermediate risk.10 To find out more about multiple myeloma, click here.

Living with smouldering multiple myeloma

People diagnosed with smouldering multiple myeloma will have regular check-ups to monitor if or how far their disease is progressing. This approach is known as active monitoring.

For those with a diagnosis, living with smouldering multiple myeloma and the uncertainty of when and how it may progress to active multiple myeloma can be very challenging for patients and their families.11 Support options through counselling or community groups with fellow patients are available and may be helpful. Speak to your doctor or healthcare team for more information and guidance on where you can access additional support.

If you are caring for someone with smouldering multiple myeloma, please visit the Carers page here for more information.

What to ask your doctor?

The list below includes some example questions to help start a conversation with your health care provider. There may be other relevant questions based on your symptoms, stage, and medical history that are not listed here.

  • What can I expect from living with smouldering multiple myeloma? How might this affect my daily life?
  • If I am asymptomatic, how often should I have my blood tested? What other tests or procedures does active monitoring involve?
  • Does smouldering multiple myeloma always develop into active disease? How quickly might this happen?
  • What clinical trials are available and am I eligible?
  • Should I be concerned about the potential for organ damage as a result of waiting for the disease to progress?
  • Can smouldering multiple myeloma develop into other types of cancer?
  • Where can I find more information about smouldering multiple myeloma?
  • If/when my disease progresses to multiple myeloma, what will my treatment options be?

References

[1]
Mayo Clinic. Myelodysplastic syndromes: Symptoms & causes. Available at: https://www.mayoclinic.org/diseases-conditions/myelodysplastic-syndrome/symptoms-causes/syc-20366977. Last accessed: September 2023
[2]
Cancer.org. What Are Myelodysplastic Syndromes? Available at: https://www.cancer.org/cancer/myelodysplastic-syndrome/about/what-is-mds.html Last accessed: September 2023.
[3]
Cancer.gov. Myelodysplastic Syndromes Treatment (PDQ®)–Patient Version. Available at: https://www.cancer.gov/types/myeloproliferative/patient/myelodysplastic-treatment-pdq Last accessed: September 2023.
[4]
MDS Foundation. What is MDS ? Available at: https://www.mds-foundation.org/what-is-mds/ Last accessed: September 2023.
[5]
Mayo Clinic. Myelodysplastic syndromes: Diagnosis. Available at: https://www.mayoclinic.org/diseases-conditions/myelodysplastic-syndrome/diagnosis-treatment/drc-20366980 Last accessed: September 2023.
[6]
Cancer.org. What Causes Myelodysplastic Syndromes? Available at: https://www.cancer.org/cancer/myelodysplastic-syndrome/causes-risks-prevention/what-causes.html Last accessed: September 2023.
[7]
NIH National Cancer Institute. Myelodysplastic Syndromes Treatment (PDQR) - Patient Version. Available at: https://www.cancer.gov/types/myeloproliferative/patient/myelodysplastic-treatment-pdq. Last accessed: September 2023.
[8]
Blood Cancer UK. Watch and wait. Available at: https://bloodcancer.org.uk/understanding-blood-cancer/watch-wait/ Last accessed: September 2023.