Screening for Multiple Myeloma Precursor Can Reduce Mortality and Slow Progression

Although almost all patients diagnosed with multiple myeloma (MM) progress from a precursor condition called monoclonal gammopathy of undetermined significance (MGUS), this condition only exists in about 2% of the overall population older than 50 years. Researchers have been trying to find a way to screen populations at high risk to detect MGUS in order to intervene early and reduce disease prevalence and mortality.

The average risk progression from MGUS to MM is at least 1% per person per year, but people with MGUS typically do not have any obvious signs or symptoms of the condition. Instead, MGUS is often diagnosed through routine blood tests.

In a paper published in JCO Clinical Cancer Informatics, researchers used a computational model of MGUS incidence and progression to predict the progression of MGUS to MM, the changes in MGUS and MM prevalence, and the annual follow-up mortality. Patients who screen positive for MGUS could seek medical care early and try strategies that could reduce their risk of progression to MM.

“Screening for MGUS may have significant benefits by lowering the incidence of multiple myeloma, provided that effective and non-toxic interventions can be identified,” explained study lead author Philipp Altrock, PhD, assistant member in the Department of Integrated Mathematical Oncology at Moffitt Cancer Center, in a statement.

The researchers found that for patients who had a higher risk of MGUS, such as men, African Americans, and those with a family history of MM, screening strategies had a larger impact to reduce the risk of disease progression and prevalence of MM. The prevalence of MM could be reduced by 19% in individuals who begin screening at age 55 and who have follow-up screening every 6 years. A similar reduction could be achieved in individuals who start screening at age 65 and have follow-up screening every 2 years.

There are currently efforts to evaluate MGUS screening and continuous follow-up before manifestation of MM in a long-term, prospective, 3-armed randomized trial. The authors also recommended additional studies be performed to confirm the effectiveness of interventions such as aspirin, metformin, or diet and exercise to prevent MGUS progression to MM.

They added that the results of their model suggest that there needs to be research to identify effective chemoprevention agents for use in patients with high-risk MGUS.

“Without further study of chemoprevention strategies, regular screening of MGUS candidates should start as early as possible, with biannual follow-up, and focus on high-risk individuals, especially those with a family history of MM, or on groups with strong indication for evolving MGUS progression,” the authors concluded.

Reference

Altrock PM, Ferlic J, Galla T, Tomasson MH, Michor F. Computational model of progression to multiple myeloma identifies optimum screening strategies [published online March 22, 2018]. JCO Clin Cancer Inform. doi: 10.1200/CCI.17.00131.