Early intervention for high-risk smoldering multiple myeloma (SMM) - PubMed
3 hours ago
- #multiple myeloma
- #systematic review
- #early intervention
- Early intervention for high-risk smoldering multiple myeloma (SMM) may prevent or delay progression to symptomatic disease.
- The review evaluates benefits and harms of early interventions like monoclonal antibodies, immunomodulatory agents, alkylating agents, and cytokine inhibitors compared to observation or placebo.
- Seven randomized controlled trials (RCTs) involving 1096 participants were included, with follow-up ranging from 29.2 months to 150 months.
- Daratumumab (a monoclonal antibody) may slightly reduce the risk of disease progression or death (HR 0.49) and mortality (HR 0.52), but evidence is low-certainty.
- Immunomodulatory agents show very uncertain evidence due to heterogeneity and conflicting results between lenalidomide and thalidomide.
- Cytokine inhibitors and alkylating agents have insufficient or very uncertain evidence to support their use in high-risk SMM.
- The decision for early treatment in high-risk SMM requires individualized risk-benefit assessment and shared decision-making.