Challenges for Physicians in the Smoldering Myeloma Setting

Sagar Lonial, MD, FACP, professor and chair, Department of Hematology and Medical Oncology and chief medical officer for the Winship Cancer Institute of Emory University, explains the 2 main challenges physicians face when they are treating patients with smoldering multiple myeloma.

Lonial discusses education for physicians and how they will have to shift their perspective when deciding how to handle cases for this patient population. The traditional method of observation alone until the patient expresses some part of the CRAB criteria (elevated calcium, renal failure, anemia, bone lesions) may change to early intervention for patients. He thinks the idea of early intervention is a new concept for some physicians who treat in the myeloma setting.

Another area of smoldering myeloma that Lonial feels is important is how long physicians treat for. Treating until complete remission may not be necessary; this disease does not have to be entirely eradicated, but instead it can be treated to prevent regression. This would mean less intensity of treatment for patients, and it would require less therapy over a shorter period of time. He says that if physicians are able to prevent the development of full-blown myeloma without eliminating the plasma cell clone, it would be a step in the right direction considering what early trials have shown in this space.

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