Should asymptomatic individuals with a strong family history of multiple myeloma (MM) undergo screening for this condition?

From the Guidelines

Asymptomatic individuals with a strong family history of multiple myeloma should not undergo routine screening for this condition, as the current evidence does not support its effectiveness in improving outcomes. The European Myeloma Network recommends against routine bone marrow examination and imaging in asymptomatic patients with low levels of M-protein, unless there are other suspicious findings or high levels of involved light-chains 1.

Screening Considerations

When considering screening, the following factors should be taken into account:

• The risk of progression to multiple myeloma is low, approximately 0.3% per year 1
• The presence of a strong family history may increase the risk, but the absolute risk remains low
• Screening may lead to earlier detection of precursor conditions like monoclonal gammopathy of undetermined significance (MGUS) or smoldering multiple myeloma, but this may not necessarily improve outcomes

Alternative Approaches

Instead of routine screening, the following approaches may be considered:

• Monitoring for symptoms suggestive of multiple myeloma or related diseases, such as anemia, bone pain, or renal impairment
• Laboratory investigations or bone marrow analysis when symptoms develop
• Consideration of individual risk factors, such as age, comorbidities, and family history, to determine the need for closer monitoring or follow-up

Follow-up and Management

For individuals with a strong family history of multiple myeloma, follow-up and management should be tailored to their individual risk factors and medical history. This may include:

• Regular health check-ups and monitoring for symptoms
• Laboratory investigations, such as complete blood count, serum protein electrophoresis, and serum free light chain assay, as needed
• Referral to a hematologist-oncologist for further evaluation and management if abnormal results are found or symptoms develop.

From the Research

Screening for Multiple Myeloma in Asymptomatic Individuals

• The decision to screen asymptomatic individuals with a strong family history of multiple myeloma (MM) for this condition is complex and requires careful consideration of various factors 2, 3, 4, 5, 6.
• Studies have shown that MM often develops from asymptomatic precursors, such as monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) 2, 3, 4.
• Early treatment of MM has been shown to improve outcomes, but the majority of patients are diagnosed after symptomatic end-organ damage has occurred 2, 4.
• Screening for MM and its precursors can be done using serum protein electrophoresis and free light chain assay, but the benefits and harms of screening are not yet fully understood 2, 5.
• A study found that the prevalence of MGUS is higher in individuals with a family history of MM, particularly those of African descent 5.
• Another study identified prognostic factors for progression from SMM to symptomatic MM, including the level and type of monoclonal protein, presence of urinary light chain, and extent of bone marrow involvement 3.
• The risk of progression from asymptomatic MM to symptomatic disease is related to the proportion of bone marrow plasma cells and the serum monoclonal protein level at diagnosis 3, 6.
• While some studies suggest that early treatment may be beneficial for high-risk patients, others argue that screening and early treatment may not be necessary for all asymptomatic individuals with a family history of MM 4, 6.

Key Considerations

• The lack of data on the benefits and harms of screening for MM and its precursors makes it difficult to recommend screening for asymptomatic individuals with a family history of MM 2.
• The definition of a target population for screening is also unclear, and more research is needed to determine who would benefit most from screening 2, 5.
• The use of mass spectrometry for screening may provide more accurate estimates of monoclonal gammopathies, but its clinical significance is still being studied 5.
• Prognostic factors, such as the level and type of monoclonal protein, can help identify individuals at high risk of progression from asymptomatic MM to symptomatic disease 3, 6.