Priority 13 from the Myeloma (Canada) PSP

UNCERTAINTY: What are new ways to monitor and/or treat the initial stages of myeloma (e.g. MGUS and smoldering myeloma) to delay or prevent the development of active myeloma? (JLA PSP Priority 13)
Overall ranking	13
JLA question ID	0113/13
Explanatory note	Monoclonal gammopathy of undetermined significance (MGUS) is a condition in which patients have M-protein present in their blood, but do not have multiple myeloma. Approximately 1% of patients with MGUS will develop myeloma each year. Smoldering myeloma is an early, asymptomatic form of myeloma before the onset of active disease. Participants wanted to see new ways to monitor and treat (e.g., chemotherapy, stem cell transplant) these precursors and prevent the development of active myeloma.
Evidence	No evidence identified
Health Research Classification System category	Cancer and neoplasms

Extra information provided by this PSP
Original uncertainty examples	Can smouldering myeloma be treated to prevent or delay it from becoming active? ~ Should people who have been diagnosed with MGUS start active therapy? ~ Can treatment start when you are MGUS or smouldering? ~ Will treating smouldering myeloma slow the progression of the disease? ~ I would like to know how early MGUS can be detected in a person. ~ It seems better to track the MGUS, as it may go on to being SMM AND then active myeloma. ~ Is there an advantage to adjuvant chemotherapy in the treatment of solitary plasmacytoma, MGUS & smouldering MM that will prevent disease progression to systemic/active myeloma?
Submitted by	Please see the PSP Engagement Summary on the JLA website

Extra information provided by this PSP

Original uncertainty examples

Can smouldering myeloma be treated to prevent or delay it from becoming active? ~ Should people who have been diagnosed with MGUS start active therapy? ~ Can treatment start when you are MGUS or smouldering? ~ Will treating smouldering myeloma slow the progression of the disease? ~ I would like to know how early MGUS can be detected in a person. ~ It seems better to track the MGUS, as it may go on to being SMM AND then active myeloma. ~ Is there an advantage to adjuvant chemotherapy in the treatment of solitary plasmacytoma, MGUS & smouldering MM that will prevent disease progression to systemic/active myeloma?

Submitted by

Please see the PSP Engagement Summary on the JLA website

PSP information
PSP unique ID	0113
PSP name	Myeloma (Canada)
Total number of uncertainties identified by this PSP.	59 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	28 April 2021