EARLY DETECTION AND INTERVENTION IN SMOLDERING MULTIPLE MYELOMA: POPULATION-BASED SCREENING AND TREATMENT

Introduction

Multiple myeloma (MM) is a bone marrow malignancy that is always preceded by asymptomatic precursor conditions, monoclonal gammopathy of undetermined significance (MGUS) or smoldering MM (SMM). SMM is a more advanced precursor and is associated with a high risk of progression to MM.

Diagnosis and Treatment Challenges

More than 94% of MM cases are diagnosed when already at the stage of full-blown malignancy and therefore do not benefit from the impact of early treatment. Recent studies indicate a benefit of early treatment, but all prior SMM studies are based on patients diagnosed due to other medical issues and are therefore biased.

Research Gaps

There are important and urgent questions on the role of screening and early treatment in SMM. There is also an unmet need to develop a risk score for progression that considers the biology and genetics of the disease.

Project Overview

In Edit-SMM, we plan to build on the success from the Iceland Screens, Treats, or Prevents MM (iStopMM) study, where remarkably over 54% of the population (N=80,759) consented to a nationwide screening for MM precursors.

Key Components of iStopMM

• Clinical evaluation and follow-up
• Biobanking
• Cross-linking to central health data registries
• Repeated questionnaires on patient-reported outcomes
• Groundbreaking methods of detection of SMM
• In-depth genetics

Objectives of Edit-SMM

Edit-SMM will identify all patients with SMM diagnosed in iStopMM. These will be followed and treated with the global objective of inducing a paradigm shift by improving diagnostics, disease classification, and population implementation of early intervention in MM by detecting and treating MM at a precursor state.

Expected Outcomes

This approach is hoped to lead to improved quality of life and potentially a cure. The main objectives are to:

1. Gather knowledge on the epidemiological, clinical, and patient-reported outcomes of SMM.
2. Perform a unique nationwide early treatment trial.
3. Leverage this unparalleled collection of samples to make major new discoveries on the biology and evolution of SMM.