by Annette M. Boyle
ST. LOUIS—Surveillance, Epidemiology and End 
Results (SEER) survival statistics for multiple myeloma 
(MM) have included the nonmalignant precursor 
or form of MM, smoldering multiple myeloma 
(SMM). That has skewed survival data by significantly 
overestimating the 5-year survival patients with symp-
tomatic MM. 
In recent studies, new research has demonstrated the 
need for more options for treatment of symptomatic MM 
in later lines to move the needle on survival. 
In addition, analyses indicate that SMM, as defined 
using the biomarker-enhanced 2014 International 
Myeloma Working Group criteria, has a markedly more 
indolent course than previously reported. 
Better understanding the risk of progression from 
SMM to MM and the expected survival rates for each 
condition has particular importance for clinicians at the 
VA. MM is a presumptive condition for veterans who 
served in the Gulf War and post-9/11 conflicts as well 
as those exposed to Agent Orange, contaminated drink-
ing water at Camp Lejeune or Marine Corps Air Station 
New River, and “atomic veterans” who participated in 
defined radiation-risk activities, such as atmospheric 
nuclear weapons testing, the occupation of Hiroshima 
and Nagasaki or radiation cleanup missions. 
In addition to service-related exposures, several 
other factors increase MM risk for veterans. These 
factors include a higher proportion of older adults, 
a predominantly male population, disproportionate 
representation of Black veterans, higher rates of obesity 
and metabolic disease and documented exposures to 
carcinogens during military service. 
Characterized by clonal proliferation of abnormal 
plasma cells in the bone marrow, MM can cause bone 
destruction, cytopenias, renal dysfunction and immune 
suppression, making timely treatment critical.
Led by John Huber, MD, and Mei Wang, researchers 
at the St. Louis VAMC and the Washington University 
School of Medicine in St. Louis published a study in 
the March issue of the Journal of the National Cancer 
Institute that broke out survival rates for SMM and 
MM. They found that including SMM in MM mortality 
Multiple myeloma in the bone marrow.  
Note the great proliferation of tumor 
plasma cells. 
MM Survival Lower  
Than Previously Reported; 
Powerful Later Line  
Options Offer Hope
Including survival statistics for the 
nonmalignant precursor of multiple 
myeloma (MM), smoldering multiple 
myeloma, has led to a significant 
overestimation of 5-year survival 
patients with MM.  But the news 
is not all bad.  Recent approval of 
powerful new later line options are 
offering hope for patients who  
have tried multiple therapies.
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