Dr Elisabet Manasanch Discusses Current Standards of Treatment for Smoldering Multiple Myeloma

There are studies exhibiting progression within treatment for smoldering multiple myeloma, but nothing has been FDA approved yet, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Transcript

How do clinicians treat patients with smoldering multiple myeloma and prevent them from progressive to full blown multiple myeloma?

The best way to do that right now is to enroll your patients in clinical trials because there is not an FDA approved therapy for this—there have been studies showing that treatment actually can make an impact. This is actually something that people have been trying to do for a long time. There have been studies in smoldering myeloma with a therapy for a long time; but it wasn't really until maybe 5, 6 years ago that there was a study that showed that this made a difference. This is why people started getting excited on treating this because before that, even for 20 years ago, people have been doing studies that really didn't show a difference, and that was probably because those therapies were not as good as the therapies we have now because we have better therapies, we can make a bigger impact. So, there are few studies, a couple of studies showing randomized studies showing that lenalidomide can make an impact when you progress to multiple myeloma. However, these therapies are not yet approved by the FDA.

So, they’re a little bit controversial about what to do. So, it's a little bit up to the physician, but again, that's not FDA approved yet, but there's a randomized few hundred patients that the largest study with lenalidomide versus observation showing that if you give lenalidomide that this can actually improve the progression free survival, meaning that you will progress less to multiple myeloma—you will remain more stable and the response rate in there were 50%. The concern with that study is also the toxicities because lenalidomide has a little bit of suppression of your blood count. So, you can get a little bit of anemia, you can get a little bit of low white count, you can maybe get infection, there's always a little bit of risk of blood clot–so, there's a little bit of toxicity and about 50% of the patients had a response that was where their myeloma was decreased by 50% or more. So, there's a little bit of controversy about what to do, and I think most people still recommend to not treat it right now, to enroll in clinical trials, but it really depends who you ask.