BETA - Is there a standardized model to ID which SMM patients are considered high-risk?

There is a lot of conversation about what is high risk small ring myeloma. To begin with, the risk we are talking about here is the risk of progression. So if an individual wants to progress from small ring myeloma to multiple myeloma, that doesn't mean that the multiple myeloma is a high risk myeloma. The risk only refers to the risk of developing multiple myeloma. It should be emphasized that all the models that are currently in the literature are based on retrospective studies. That means that institutions have collected data from individuals that came to these institutions and then investigators have gone through the databases to see at baseline of these individuals' visits if they could identify factors that were different in those individuals who progressed versus those who did not. Using these different types of approaches, different groups have referred to high intermediate and low risk categories. If you compare one model to another, many studies have done that published in high impact journals. They show that there is very poor concordance. So it would be very practical if you have 300 patients and 100 patients of high risk, 100 intermediate risk, and 100 patients of low risk with one model. If you apply the variables from another model to those 300 patients, patients that are in the low risk group could move to the intermediate group or high risk could even move to the low risk or intermediate could move to both low and high and so forth. So if you do a third test, patient would move again. And if you do a fourth test, in my practice when patient asks me, am I low risk? Am I high risk? Am I intermediate risk? I many times go over the different models and say this model would suggest you are high risk while this model would suggest you are low risk. So I ask the patient, do you want to be high risk or low risk? And the patient is looking at me and saying, what are you talking about? Then I say, the problem is that these models are not perfect. So we go over the data and say my interpretation overall would be that the risk is probably in this direction, but there is no perfect model. Also, I emphasize very importantly that all these models are probability models, meaning that the example I gave with 100 patients in each of the groups, let's say the low risk group is 25 risk of progression. The intermediate group is 50% of progression and the high risk, let's say 75% risk of progression. That means that there are progressives in all the three groups and there are also non-progressives in all the three groups. None of these models can answer the risk for the individual patient and you don't know if you are a progressor or non-progressor in the group. You only know in which of the groups you belong to based on this model. So what the field is currently lacking is the equivalent of a pregnancy test. So pregnant, non-pregnant, you cannot be intermediate pregnant or high risk or low risk pregnant. Is pregnant or not pregnant? So the field does not have yet a test that would say that this biology, unfortunately this is a biology that is programmed towards progression or this is good news, not associated with progression. That test is not yet available, but this is happening in these new studies I was referring to before where you can use low input DNA whole genome sequencing and you can actually profile these low amounts of precursor cells and you can identify the same signatures as you see in myeloma or not and you can split both the monoclonal hemopathy and the so-called small ring myeloma together into two entities and I think that is where the field will be heading. you