Vincent Rajkumar, Professor of Medicine at the Mayo Clinic in Rochester and Editor‑in‑Chief at Blood Cancer Journal, shared a post on X:
“Is smoldering myeloma a malignancy or premalignancy?
Check out this paper in JCO where we show that almost all high risk smoldering myeloma (and most intermediate and low risk smoldering myeloma) has genomic malignancy signatures identical to active myeloma. Based on the natural history we had previously considered that smoldering myeloma as a heterogenous clinical definition with a mix of patients some with malignancy (myeloma) and some with biological premalignancy. That theory explained the SMM progression curve where we had a high rate of progression in the first 5 years. 
But our studies show genomically most smoldering myeloma is malignancy, but as in other cancers some (especially low and intermediate risk SMM) do not progress despite having evidence of malignant transformation. We think this is likely due to immune control or other microenvironmental factors. And needs to be studied carefully because it can help us determine and refine management strategies.”
Title: Genomics Define Malignant Transformation in Myeloma Precursor Conditions.
Authors: Francesco Maura, P. Leif Bergsagel, Bachisio Ziccheddu, Shaji Kumar, Kylee Maclachlan, Andriy Derkach, Juan-Jose Garces, Ross Firestone, Esteban Braggio, Yan Asmann, Michael Durante, Benjamin T. Diamond, Marios Papadimitriou, Malin Hultcrantz, Alessio Marella, Giancarlo Castellano, Akihiro Maeda, Marta Lionetti, Antonio Matera, Stefania Pioggia, Matteo Claudio Da Vià, Claudio de Magistris, Daniel Leongamornlert, Danny DeAvila, Praneeth Reddy Sudalagunta, Rafael Renatino Canevarolo, Erin M. Siegel, Phaedra Agius, Jamie Teer, Andrew McPherson, Yusuke Yamashita, Ariosto S. Silva, Patrick Blaney, Rachid Baz, Krina K. Patel, Peter Campbell, Gareth Morgan, Rafael Fonseca, Ola Landgren, Robert Z. Orlowski, Kenneth H. Shain, Niccolo Bolli, Saad Usmani, S. Vincent Rajkumar.
More post from Vincent Rajkumar on OncoDaily.