Screening for premalignant precursor conditions could serve as an important step in the early detection and treatment of multiple myeloma. However, more insights are needed to determine the optimal criteria for screening programs, experts say, based on their recently presented research at the 2021 Annual Meeting of the American Society of Hematology (ASH).
By screening for monoclonal gammopathy of undetermined significance (MGUS) and the subsequent smoldering multiple myeloma (SMM) phase—both asymptomatic precursors to multiple myeloma—physicians could monitor the disease from a much earlier stage.
Despite the potential benefit, some have noted that identifying the right approach to screen for MGUS in subjects remains a challenge, particularly in terms of determining those who could develop malignant conditions. Finding the most appropriate age cohort for such screenings also mandates further insight, namely in terms of selecting a cut-off point where patients at an advanced age may not benefit from being diagnosed with the precursor conditions. Furthermore, MGUS screenings could have a potentially harmful psychological impact on those who may not develop the malignant condition.
Recent research findings presented at the 2021 ASH meeting have increased the interest in exploring wide-scale screening programs. One study that recently screened populations at risk of contracting multiple myeloma—African Americans and those having a first-degree relative with a hematological malignancy—found older African Americans have a high prevalence of MGUS and could benefit from screening programs for potential clinical intervention. Similarly, a nationwide screening of over 75,000 Icelandic subjects concluded that population screenings could allow early interventions, but further insight is needed regarding their use in healthy populations.
Multiple myeloma evolves from conditions known as MGUS and SMM, which remain clinically detectable but also premalignant. However, since these precursors can later develop into multiple myeloma, monitoring them presents a potential opportunity for early detection and treatment, experts say.
Yet, while screening programs have been implemented to identify solid tumors such as breast or colon cancer, this is not the case for MM, says Catherine Marinac, PhD, assistant professor of medicine at the Harvard Medical School. Marinac participated in the PROMISE study, which looked at individuals at high risk for contracting multiple myeloma.
Indeed, some blood tests used to screen for multiple myeloma and its premalignant precursors, such as serum protein electrophoresis or free light chain assay, are relatively affordable and available, says Dr Samundur Rognvaldsson, who took part in the Icelandic iStopMM study. Additionally, such measures only require a blood test, rather than a more intensive intervention, says Rögnvaldsson, who is also a PhD candidate at the University of Iceland, Reykjavik.
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