Efficacy and toxicity of treatment of smoldering multiple myeloma: a systematic review and meta-analysis
Early intervention may delay progression and improve clinical responses, especially in high‑risk smoldering multiple myeloma.
Smoldering multiple myeloma (SMM) is an asymptomatic precursor to multiple myeloma. We performed a systematic review and meta‑analysis of 19 studies (5 randomized controlled trials and 14 non‑randomized single‑arm trials) involving 1,217 patients to evaluate the efficacy and safety of novel agent‑based therapies in SMM, particularly high‑risk patients. Pooled 12‑month progression‑free survival and overall survival rates were 94% and 99%, respectively, while the overall response rate was 64% and complete response rate 12%. Grade 3/4 adverse events occurred in 36% of patients in the intervention groups versus 25% in controls. High‑risk SMM patients had greater benefits in progression‑free survival, response rates, and similar overall survival, with comparable toxicity. These findings support early intervention to delay progression but underscore the need for further well‑designed randomized trials.
Understanding whether early therapeutic intervention can postpone the transition from smoldering to active multiple myeloma could reduce disease burden and improve quality of life in patients, especially those at high risk of progression.
Evidence level: Korai humán adat. Kis vagy feltáró emberi adat.
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