Some smoldering myeloma patients could be at ultra-high risk of developing myeloma within a 2-year window. If hemoglobin is reduced and the monoclonal-protein (M-protein) is increasing, patients may be at risk. These findings were reported at the recent ASCO 2016 conference, the largest oncology conference in the world.

In the study, if hemoglobin declined at a rate of 0.5 g/dL a year at the same time there was a 10% or greater rise in M-protein and other parameters, there was an 80% chance this individual with smoldering multiple myeloma would be diagnosed with the full-blown disease within 24 months, said Praful Ravi, MBBCh, of the Mayo Clinic, in Rochester, Minn, and colleagues.

Also, if patients exhibited those two risk factors as well as an increase in clonal bone marrow plasma cells, then the risk of progression to multiple myeloma within 2 years was greater that 90%, Ravi added. But Ravi cautioned that more work is needed before physicians can act on his group's findings.

For the study, the group identified patients diagnosed with smoldering multiple myeloma who were treated at Mayo from 1973 to 2014. Patients who received myeloma-specific therapy before progression or without adequate follow-up to permit study of evolving changes in biomarkers were excluded. They defined the increase as a growth in the M-protein levels of 10% or more within 6 months of diagnosis and/or a 25% or greater increase in M-protein and/or involved immunoglobulin within the first 12 months.

About 14% of newly diagnosed multiple myeloma patients have smoldering disease. The risk of progression to multiple myeloma is 10% per year for the first 5 years, and then 3% per year for the next 3 years, and then 1% per year thereafter.

"The work in smoldering multiple myeloma is in evolution," said Sagar Lonial, MD, of the Winship Cancer Center at Emory University in Atlanta. "There has been a lot of talk about intervening early in the smoldering myeloma patient population, and there have been some very small pilot studies that have shown very encouraging data by treating those patients early."

"The challenge is that we really don't know what the long-term outcome is," explained Lonial, who was not involved in the study. "It is not a surprise to me that if we treat a newly diagnosed myeloma patients with that regimen, you are going to get great responses. But this is a long game; it is not a short game."

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