The 20/2/20 risk stratification model for Smoldering Myeloma
Oncologists use 20/2/20 model to calculate risk score to predict progression risk to active myeloma at 2 years for each individual patient.
Bone marrow plasma cells >20 percent ( 3 points or more)
M protein >2 g/dL ( 3 points or more)
Involved/uninvolved free light chain (FLC) ratio >20 (2 points or more)
FISH abnormality ( 2 points)
If total risk Score is 0-4 there is 3.7% risk of progressing into active myeloma at 2 years.
If total risk Score is 5-8 there is 25.4% risk of progressing into active myeloma at 2 years.
If total risk Score is 9-12 there is 48.9% risk of progressing into active myeloma at 2 years.
If total risk Score is >12 there is 72.6% risk of progressing into active myeloma at 2 years.
This information is used by oncologists to recommend treatment choice for Smoldering MM. Starting treatment for Myeloma or enrollment into clinical trial. Focus is to get patient started on active treatment to prevent progression into active myeloma and to prevent end organ damage ( CRAB) Myeloma defining events.
Patient is assigned one of the categories based on risk score.
Low risk group (0-4)
Low-intermediate risk group (5-8)
Intermediate risk group (9-12)
High risk group >12
Mayo 2018 risk stratification system (20/2/20 criteria):
Bone marrow plasma cells >20 percent
M protein >2 g/dL
Involved/uninvolved free light chain (FLC) ratio >20
Updated risk stratification model for smoldering multiple myeloma (SMM) incorporating the revised IMWG diagnostic criteria.
Background: The diagnostic criteria for MM were revised in 2014, recategorizing ultra-high risk (i.e., 80% at two years) as active myeloma requiring therapy. The removal of patients at the highest risk of progression from the smoldering group requires reassessment of current risk stratification models.
Conclusions: We have developed a risk stratification model for SMM that incorporates revised cutoffs for previously used parameters (20/2/20) that can be universally applied.
Additional analysis are being conducted to develop models that utilize common cytogenetic abnormalities, as well as those without FLC given lack of availability of all tests across the world.
2019 ASCO Annual Meeting
blood cancer journal; Open Access - Published: 16 October 2020