Current paradigm and proposed future directions
| Current paradigm . | Proposed future directions . | Comments . |
|---|---|---|
| Risk of MGUS | Monoclonal gammopathy | All these precursor stages have similar low risk of developing multiple myeloma. They are not cancer; they are precursor stages. With new data that link the precursor and multiple myeloma together,18 the “uncertain significance” terminology is no longer relevant. It seems reasonable to propose the terminology “monoclonal gammopathy.” |
| Low | ||
| Intermediate | ||
| High | ||
| Risk of smoldering multiple myeloma | ||
| Low | Monoclonal gammopathy | Similar risk of conversion to multiple myeloma as MGUS. The PETHEMA model shows 5% risk at 5 y of follow-up. |
| Intermediate | Indolent multiple myeloma | Regarding the role of early treatment in the group of patients with indolent multiple myeloma, it is less obvious to form strategies. For example, in indolent lymphomas,33 early intervention vs delayed intervention (eg, at rising biomarkers) are both options that may be proposed. Clinical trials are needed to answer these questions in a rational manner. |
| High | Multiple myeloma (early detection) | That these patients, using 2014 IMWG terminology for multiple myeloma, develop formal criteria for multiple myeloma within 1 to 2 y indicates that they have the same disease as patients with multiple myeloma, just at an earlier stage.7,19 Consequently, these patients require therapy as much as patients fulfilling the the current criteria for multiple myeloma. This is very similar to many other conditions clinicians manage in their daily practices (eg, early breast cancer) |
| Multiple myeloma | Multiple myeloma | Requiring therapy |
| Current paradigm . | Proposed future directions . | Comments . |
|---|---|---|
| Risk of MGUS | Monoclonal gammopathy | All these precursor stages have similar low risk of developing multiple myeloma. They are not cancer; they are precursor stages. With new data that link the precursor and multiple myeloma together,18 the “uncertain significance” terminology is no longer relevant. It seems reasonable to propose the terminology “monoclonal gammopathy.” |
| Low | ||
| Intermediate | ||
| High | ||
| Risk of smoldering multiple myeloma | ||
| Low | Monoclonal gammopathy | Similar risk of conversion to multiple myeloma as MGUS. The PETHEMA model shows 5% risk at 5 y of follow-up. |
| Intermediate | Indolent multiple myeloma | Regarding the role of early treatment in the group of patients with indolent multiple myeloma, it is less obvious to form strategies. For example, in indolent lymphomas,33 early intervention vs delayed intervention (eg, at rising biomarkers) are both options that may be proposed. Clinical trials are needed to answer these questions in a rational manner. |
| High | Multiple myeloma (early detection) | That these patients, using 2014 IMWG terminology for multiple myeloma, develop formal criteria for multiple myeloma within 1 to 2 y indicates that they have the same disease as patients with multiple myeloma, just at an earlier stage.7,19 Consequently, these patients require therapy as much as patients fulfilling the the current criteria for multiple myeloma. This is very similar to many other conditions clinicians manage in their daily practices (eg, early breast cancer) |
| Multiple myeloma | Multiple myeloma | Requiring therapy |
To caution the reader and to avoid confusion in the clinical field, before going forward, these ideas and concepts will have to be agreed on and endorsed in a consensus document.