Risk models of progression from SMM to active MM
| Model . | Risk factors . | Risk groups . | Outcomes . |
|---|---|---|---|
| PETHEMA | 1. ≥95% aberrant BMPCs by flow cytometry (defined as CD38+ cells with absence or underexpression of CD19 and/or CD45 or overexpression of CD56) 2. Immunoparesis (reduction of ≥1 uninvolved heavy chain) | 0, low risk 1, intermediate 2, high risk | PFS at 5 y: Low risk, 4% Intermediate risk, 46% High risk, 72% |
| Mayo 2008 | 1. BMPCs ≥10% 2. M spike ≥3 g/dL 3. sFLC ratio ≤0.125 or ≥8 | 0/1, low risk 2, intermediate risk 3, high risk | PFS at 5 y: Low risk, 25% Intermediate risk, 51% High risk, 76% |
| Mayo 2018 | 1. BMPCs >20% 2. M spike >2 g/dL 3. sFLC ratio <0.05 or >20 | 0, low risk 1, intermediate risk 2/3, high risk | Median TTP: Low risk, 110 mo Intermediate risk, 68 mo High risk, 29 mo |
| IMWG 2020 | 1. sFLC ratio: 0-10, 0 points 10-25, 2 points 25-40, 3 points >40, 5 points 2. M spike (g/dL): 0-1.5, 0 points 1.5-3, 3 points >3, 4 points 3. Percentage of BMPCs 0-15, 0 points 15-20, 2 points 20-30, 3 points 30-40, 5 points >40, 6 points 4. FISH abnormalities* No, 0 points Yes, 2 points | 0-4 points, low risk 5-8 points, low/intermediate risk 9-12 points, intermediate risk >12 points, high risk | Risk of progression at 2 y: Low risk, 3.8% Low/intermediate risk, 51.1% Intermediate risk, 26.2% High risk, 72.5% |
| Model . | Risk factors . | Risk groups . | Outcomes . |
|---|---|---|---|
| PETHEMA | 1. ≥95% aberrant BMPCs by flow cytometry (defined as CD38+ cells with absence or underexpression of CD19 and/or CD45 or overexpression of CD56) 2. Immunoparesis (reduction of ≥1 uninvolved heavy chain) | 0, low risk 1, intermediate 2, high risk | PFS at 5 y: Low risk, 4% Intermediate risk, 46% High risk, 72% |
| Mayo 2008 | 1. BMPCs ≥10% 2. M spike ≥3 g/dL 3. sFLC ratio ≤0.125 or ≥8 | 0/1, low risk 2, intermediate risk 3, high risk | PFS at 5 y: Low risk, 25% Intermediate risk, 51% High risk, 76% |
| Mayo 2018 | 1. BMPCs >20% 2. M spike >2 g/dL 3. sFLC ratio <0.05 or >20 | 0, low risk 1, intermediate risk 2/3, high risk | Median TTP: Low risk, 110 mo Intermediate risk, 68 mo High risk, 29 mo |
| IMWG 2020 | 1. sFLC ratio: 0-10, 0 points 10-25, 2 points 25-40, 3 points >40, 5 points 2. M spike (g/dL): 0-1.5, 0 points 1.5-3, 3 points >3, 4 points 3. Percentage of BMPCs 0-15, 0 points 15-20, 2 points 20-30, 3 points 30-40, 5 points >40, 6 points 4. FISH abnormalities* No, 0 points Yes, 2 points | 0-4 points, low risk 5-8 points, low/intermediate risk 9-12 points, intermediate risk >12 points, high risk | Risk of progression at 2 y: Low risk, 3.8% Low/intermediate risk, 51.1% Intermediate risk, 26.2% High risk, 72.5% |
PETHEMA, Programa Español de Tratamientos en Hematología.
FISH abnormalities include t(4;14), t(14;16), 1q gain, and del 13q/monosomy 13.