Management

Early intervention is not required in patients with asymptomatic myeloma (1).

• only requires close monitoring under the supervision of a consultant haematologist
• entry into clinical trials (if available) should be considered in this group
• chemotherapy may be beneficial in patients with a rising M-protein concentration in the absence of ROTI (1)

The overall risk of progression to symptomatic myeloma during the first 5 years is around 10% per year but declines in subsequent years.

Monitoring of asymptomatic myeloma patients include the following:

• regular (typically 3 monthly) clinical assessment for the emergence of ROTI
• measurement of serum and urinary M-protein (and SFLC when indicated) (1)

A repeat of bone marrow examination and skeletal imaging should be considered before starting therapy in these patients (1).

The ability of immunomodulatory drugs to delay the progression from asymptomatic to symptomatic myeloma is under investigation (2).

Reference:

• 1. Bird JM et al. Guidelines for the diagnosis and management of multiple myeloma 2011. Br J Haematol. 2011;154(1):32-75.
• 2. Palumbo A, Anderson K.Multiple myeloma. N Engl J Med. 2011;364(11):1046-60.