Prevalence of multiple myeloma precursors revealed for the first time with iStopMM results
• Researchers at the University of Iceland have for the first time uncovered the prevalence of smoldering multiple myeloma, which is a precursor to bone marrow cancer
• The findings indicate that smoldering multiple myeloma is present in 0.5% of people over 40
• People with this precursor condition, in cases where it has a high chance of developing into malignant multiple myeloma, will probably be invited to start drug treatment in the next few years
By screening over 75,000 people in Iceland with blood tests and over 1,600 with bone marrow biopsies, researchers at the University of Iceland have for the first time revealed the prevalence of smoldering multiple myeloma (SMM), which is a precursor to multiple myeloma. Their findings have been published in Nature Medicine, one of the most prestigious academic journals in the world.
Multiple myeloma is a form of bone marrow cancer that can cause anaemia, kidney failure and thinning bones. This form of cancer and its precursors have been the focus of a major study, iStopMM, conducted by a team of researchers at the University of Iceland and the National University Hospital. The team have been awarded hundreds of millions of ISK in grant money to pursue this vital research.
Part of the outcome of that research was recently published in Nature Medicine in a paper detailing findings that indicate SMM is present in 0.5% of people over the age of 40. The condition is more common in men than women and the prevalence increases with age. Research also shows that most people diagnosed with multiple myeloma precursors have a proportionally low risk of going on to develop malignant cancer. The iStopMM study is unique. Never before have so many people been screened for this asymptomatic precursor condition, meaning this is the first time we have been able to estimate its prevalence.
The authors of the paper include the doctors Sigrún Þorsteinsdóttir and Sigurður Yngvi Kristinsson, along with a large team of people, mostly working at the University of Iceland and the National University Hospital. Sigrún and Sigurður explain that these results are highly significant, since two drug trials suggest that starting treatment for multiple myeloma before it causes symptoms and organ damage can improve patient outcomes. The findings of iStopMM suggest that a screening programme could be used to identify these individuals. However, further research is required to determine which groups are most at risk of developing organ damage related to multiple myeloma, making it possible to offer drug treatments to the right people and effectively monitor those who are at less risk.
"International experts in multiple myeloma have been very interested in our research, in particular the uniquely high participation rate which means that our findings on multiple myeloma precursors are much more reliable than those of previous studies," explains Sigrún Þorsteinsdóttir, postdoctoral researcher at the University of Iceland and doctor at Copenhagen University Hospital, who is the first author of the paper. She first presented their findings at a conference in Atlanta in December 2021, which was attended by around 15,000 people.
"There has never been a study like iStopMM anywhere in the world. The positive response we've had is testament to what a small but united nation can achieve, because our study would be nothing without the remarkable cooperation of the participants and the extraordinary willingness among Icelanders to contribute to science. For that we are truly grateful," says Sigurður Yngvi Kristinsson, professor of hematology at the University Faculty of Medicine and specialist at the National University Hospital. Sigurður leads the interdisciplinary team of researchers.
More about iStopMM
The iStopMM study began in 2016. Everyone in Iceland born in 1975 or earlier was invited to take part by undergoing a blood test. The response was overwhelmingly positive. Over 80,000 people signed up for the study and roughly 75,000 have had the blood test. The aim of the study is to investigate the impact of screening, to explore the causes and consequences of multiple myeloma, and to increase the quality of life and prognosis of people diagnosed with the disease. People with SMM, as identified by the screening programme, have been invited to take part in a treatment trial aimed at preventing the disease from progressing to multiple myeloma. Participants diagnosed with monoclonal gammopathy of undetermined significance, an earlier precursor condition, have also been offered annual monitoring.
