Dr. Lonial on Differentiating Patients With Smoldering and Multiple Myeloma

Sagar Lonial, MD, professor and chair, Department of Hematology & Medical Oncology, Emory University School of Medicine, chief medical officer, Winship Cancer Institute of Emory University, discusses differentiating patients with smoldering myeloma and multiple myeloma.

There are new definitions of multiple myeloma and ways to differentiate patients with smoldering myeloma, explains Lonial. It is known that smoldering myeloma can be risk stratified with simple tests, such as a bone marrow biopsy, magnitude of the M protein, and free light chain ratio.

It is also known that the Myeloma Working Group redefined myeloma a few years ago, says Lonial. Patients with high free light chain ratios of greater than 100 or bone lesions detected by MRI or PET scan that were greater than 60% are now considered as multiple myeloma and not smoldering myeloma.

Additionally, a skeletal survey in a patient with smoldering or monoclonal gammopathy of undetermined significance (MGUS) myeloma is no longer the standard of care. More advanced imaging is needed to ensure that patients do not have occult bone disease that might have been missed with a skeletal survey.