A study published in The New England Journal of Medicine this month (the abstract can be read at: http://tinyurl.com/yweyh9) looks at the risk of progression from SMM (or smoldering or inactive or asymptomatic myeloma) to symptomatic MM or amyloidosis. Digression: have you ever had an amyloidosis test? I have, and I must say that I almost prefer a BMB! For me, at least, that test was horrible. But it turned out that I do not have amyloidosis, so that at least is a relief. Back to us.
Mayo Clinic researchers looked at 276 patients diagnosed with SMM, most of whom had the IgG type, between 1970 and 1995. The patients were between the ages of 26 and 90 (median age: 64). Only eight patients, or 3 %, were under the age of 40. 59% of all patients eventually developed MM. I won’t repeat what is available online (i.e., what’s written in the abstract), but give a summary of some of the more interesting points made in the full study, which I was lucky enough to read. First, following the study’s indications, let me define SMM. A diagnosis of smoldering myeloma is based on the presence of a serum monoclonal protein level of 3 grams (or more) per deciliter, or the presence of 10% (or more) malignant cells in the bone marrow, but no symptoms, such as too much calcium in the blood, kidney problems, anemia, bone lesions (these are also known as the four CRAB symptoms), or persistent bacterial infections. In other words, no end-organ damage. SMM, like MGUS, should not be treated.
The study divided the above-mentioned patients into three groups: group 1 had a proportion of bone marrow plasma cells of 10% or more and a serum monoclonal protein level of 3 g per deciliter or more; group 2, 10% or more bone marrow plasma cells and a serum monoclonal protein level of less than 3 g per deciliter; and group 3, less than 10% bone marrow plasma cells and a serum monoclonal protein level of 3 g per deciliter or more. Based on this scheme, I would be in the second group.
Progression to MM was more likely with a higher level of monoclonal protein 5 grams versus 2 grams/dL “at the time of diagnosis. (Interestingly, factors such as gender, haemoglobin, serum albumin level had little to do with progression.) Median time to progression was two years for those in group 1, eight years for group 2, and 19 years for group 3. The cumulative probability of progression at 15 years was 87% for the 106 patients in group 1 (10% plasma cells and 3 g or more of monoclonal protein per deciliter), 70% for the 142 patients in group 2 (10% plasma cells and <3 g of monoclonal protein per deciliter), and 39% for the 27 patients in group 3 (<10% plasma cells and 3 g, or more, of monoclonal protein per deciliter). Time was found to be of the essence: the more time passed after the initial SMM diagnosis, the better (more details can be found in the abstract). This is a big difference between SMM and MGUS, where time is not a factor.
What do I conclude from all of these statistics? First of all, let me say that, while this is a very interesting study, numbers don’t scare me. Not a bit. Besides, all we know about these patients is that they had SMM. That’s it. No information on diet, supplement intake (if any) and so on. Too much perhaps vital information is missing, here. Understandably so, of course, given the long period of time involved, i.e., 26 years. But still…
Secondly, as I suppose is slightly obvious from my blog 😉 , I am a devoted curcumin-taker, and curcumin has stopped the progression of my MM right in its tracks. My future IgG trend (plotted by my husband on a graph) is finally a downward one. Yet in January of 2006, I would have been in group 1, based on this study. I am now in group 2. And by the end of the year, who knows? (The eternal optimist, as always!)
Therefore, my advice for those who are still lucky enough not to have active disease: it’s time to act. The wait until the other shoe drops off attitude, which I have seen posted more than once on one of the MM listservs, infuriates me. And if your doctor scoffs at diet or exercise or supplements that have scientific backing (and curcumin is not the only one ), pay no attention. Look up the studies, print them out and take them to your doctor. That’s what I have done and still do. The best patient, or perhaps the most annoying one (depending on your point of view!) is a well-informed one.
Great post Margaret!
On top of what you report, the authors of the Blood article make clear that the results of the FISH test (a very recent one) were not taken into account. I suspect that with the FISH test many of the patients would have been classified in a different group.
Have a nice day.
I’ve seen other definitions of the borderline between MGUS and SMM. Some say 10% or more plasma cells in the bone marrow, while others say 10% ABNORMAL plasma cells. Have you seen that?
I ask because in my case it makes a big difference. At my very first BMB I had 9.7% plasma cells (counted electronically) but only 0.5% “abnormal cohort” (estimated by the doctor).