Early Detection and Intervention in Smoldering Multiple Myeloma: population-based screening and treatment; Edit-SMM

Sigurður Kristinsson

MD PhD

University of Iceland

Project Term: July 1, 2022 - June 30, 2027

Project Summary

Multiple myeloma (MM) is the second most common blood cancer. Close to 100,000 people die every year from MM globally and more new cases are diagnosed every year. Patients with MM have symptoms that seriously affect their quality of life such as severe pain, infections, and fatigue and most patients eventually die from the disease. MM 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. 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. 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. 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. 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. It includes 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, and in-depth genetics. Edit-SMM will identify all patients with SMM diagnosed in iStopMM. These will be followed and treated to gather knowledge on the epidemiological, clinical, and patient reported outcomes of SMM, perform a unique nationwide early treatment trial, and leverage this unparalleled collection of samples to make major new discoveries on the biology and evolution of SMM. This will help us achieve the global objective Edit-SMM which is inducing a paradigm shift by improving the diagnostics, disease classification, and population implementation of early intervention in MM by detecting and treating MM at a precursor state, hopefully leading to improved quality of life and potentially a cure.