Early treatment for high-risk smouldering myeloma: has the time come?
Mené en Espagne et au Portugal sur 125 patients atteints d'un myélome multiple asymptomatique à haut risque, cet essai multicentrique randomisé de phase III évalue l'efficacité, du point de vue du délai avant progression en maladie symptomatique, et la toxicité d'un traitement combinant lénalidomide et dexaméthasone
A central question in oncology refers to the optimum timing of treatment initiation in asymptomatic patients with a malignant phenotype. Early treatment initiation did not improve survival in studies of chronic lymphocytic leukaemia and asymptomatic low-grade non-Hodgkin lymphoma, but this outcome might change with the use of novel drugs. In smouldering multiple myeloma—a precursor state of active myeloma—several attempts to improve patient outcomes remained futile, for two main reasons. First, the prognosis of patients with smouldering myeloma is very heterogeneous, with some patients progressing to multiple myeloma rapidly and others only after long-term follow-up or even not at all.
The Lancet Oncology , commentaire, 2015