Conference Coverage

Key to MGUS and myeloma may lie in Iceland



– Everyone aged 40 years and older on the island nation of Iceland is being screened for monoclonal gammopathy of undetermined significance, smoldering myeloma, and full-blown multiple myeloma in an unprecedented project to identify the malignancy’s genetic roots, Joseph Mikhael, MD, said at the annual meeting of the American College of Physicians.

This effort to decode the underlying genetics of multiple myeloma is enormously facilitated by the fact that the DNA sequencing of the entire Icelandic population is already known, and everyone’s blood samples are stored in the national health care system.

Dr. Joseph Mikhael, chief medical officer at the International Myeloma Federation Bruce Jancin/MDedge News

Dr. Joseph Mikhael

Embedded within the larger Icelandic project is a randomized, controlled clinical trial. In that trial, individuals who screen positive for monoclonal gammopathy of undetermined significance (MGUS) or smoldering myeloma will be assigned to early intervention or the standard watch-and-wait approach to establish whether a proactive intervention strategy favorably alters the natural history of multiple myeloma and improves survival, explained Dr. Mikhael, chief medical officer at the International Myeloma Foundation.

The International Myeloma Foundation is funding the Icelandic project, called iStopMM (Iceland Screens Treats or Prevents Multiple Myeloma).

The results of iStopMM could be far reaching, in part because the findings will show whether screening an asymptomatic general population for MGUS – as for example, all American adults – is worthwhile.

In the interim, it’s important for primary care physicians to recognize when it is and isn’t appropriate to order a serum protein electrophoresis (SPE) study, on which the diagnosis of MGUS hinges. It’s also essential to recognize the difference between smoldering and full-blown multiple myeloma, because the distinction has implications for patient monitoring and treatment, added Dr. Mikhael, a hematologist at the City of Hope Cancer Center in Duarte, Calif.

Multiple myeloma accounts for 1% of all cancers and 10% of hematologic malignancies. MGUS is an obligate precursor of multiple myeloma. But MGUS is common, and therein lies a challenge for physicians – as well as a major source of anxiety for many MGUS-positive patients.


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