The Multiple Myeloma Hub spoke to Irene Ghobrial, Dana-Farber Cancer Institute, Boston, US. We asked about risk stratification and prognosis in smoldering multiple myeloma (MM).

During this interview, Ghobrial discussed risk stratification and prognosis in smoldering MM, with a focus on whether high-risk smoldering MM should be treated early. Ghobrial emphasized the heterogeneity of the condition, which ranges from indolent disease to high-risk cases with an approximately 50% likelihood of progression within 2 years. High-risk smoldering MM is a true malignancy, with plasma cells actively proliferating despite the absence of symptoms or myeloma-defining events. Early treatment was highlighted as a potential opportunity to achieve long-term disease control, with supporting data from the AQUILA study and other clinical trials indicating that therapies such as daratumumab can improve progression-free and overall survival for these patients. Ghobrial concluded by noting that advances in immunotherapy, including bispecific antibodies and CAR T-cell therapy, may enable earlier, fixed-duration treatment strategies that prevent end-organ damage and potentially achieve cure in high-risk smoldering MM.

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