{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T07:52:42Z","timestamp":1790409162739,"version":"4.1.0"},"reference-count":20,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"27","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2024,9,20]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Early treatment of high-risk smoldering myeloma has been shown to delay progression to multiple myeloma (MM). We conducted this trial with curative intention using a treatment approach employed for newly diagnosed patients with MM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      Patients with high-risk smoldering myeloma (&gt;50% progression risk at 2 years) and transplant candidates were included and received induction therapy with carfilzomib, lenalidomide, and dexamethasone (KRd), six cycles, followed by high-dose melphalan (200 mg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) autologous stem-cell transplantation (HDM-ASCT), two KRd consolidation cycles, and Rd maintenance for 2 years. The primary end point was undetectable measurable residual disease (uMRD) rate by next-generation flow after ASCT. Sustained uMRD 4 years after ASCT was the secondary end point.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Between June 2015 and June 2017, 90 patients were included, and 31% met at least one SixtyLightchain MRI (SLiM)-hypercalcemia, renal impairment, anemia, bone disease (CRAB) criterion. After a median follow-up of 70.1 months, 3 months after ASCT, in the intention-to-treat population, 56 (62%) of 90 patients had uMRD, and 4 years later, it was sustained in 29 patients (31%). Five patients progressed to MM, and the 70-month progression rate was 94% (95% CI, 84 to 89). The presence of any SLiM CRAB criteria predicted progression to MM (four of the five patients; hazard ratio, 0.12; 95% CI, 0.14 to 1.13; P = .03). Thirty-six patients showed biochemical progression, and failure to achieve uMRD at the end of treatment predicted it. The 70-month overall survival was 92% (95% CI, 82 to 89). Neutropenia and infections were the most frequent adverse events during treatment, resulting in one treatment-related death. Three second primary malignancies have been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Although a longer follow-up is needed, this curative approach is encouraging and more effective than active MM, with 31% of the patients maintaining the uMRD 4 years after HDM-ASCT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco.23.02771","type":"journal-article","created":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T16:03:20Z","timestamp":1721664200000},"page":"3247-3256","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":37,"title":["Curative Strategy for High-Risk Smoldering Myeloma: Carfilzomib, Lenalidomide, and Dexamethasone (KRd) Followed by Transplant, KRd Consolidation, and Rd Maintenance"],"prefix":"10.1200","volume":"42","clinical-trial-number":[{"clinical-trial-number":"nct02415413","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2390-1218","authenticated-orcid":false,"given":"Mar\u00eda-Victoria","family":"Mateos","sequence":"first","affiliation":[{"name":"Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC and Centro de Investigaci\u00f3n del C\u00e1ncer, IBMCC (USAL-CSIC), Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7908-0063","authenticated-orcid":false,"given":"Joaquin","family":"Mart\u00ednez-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital 12 de Octubre, Medicine Department, Medicine School of Complutense University, I+12. CNIO, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5236-7785","authenticated-orcid":false,"given":"Paula","family":"Rodriguez Otero","sequence":"additional","affiliation":[{"name":"Hematology Department, Cancer Center Clinica Universidad de Navarra (CCUN), Cima, CIBERONC, Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ver\u00f3nica","family":"Gonz\u00e1lez-Calle","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Salamanca, Spain"},{"name":"Centro de Investigaci\u00f3n del C\u00e1ncer-IBMCC (USAL-CSIC), Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta Sonia","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Clinico Universitario Santiago de Compostela, Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6804-2221","authenticated-orcid":false,"given":"Albert","family":"Oriol","sequence":"additional","affiliation":[{"name":"Clinical Hematology, Institut Catal\u00e0 d\u2019Oncologia and Josep Carreras Research Institute, Hospital Germans Trias I Pujol, Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5834-9510","authenticated-orcid":false,"given":"Norma C.","family":"Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Hematology Department, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain"},{"name":"Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de C\u00e1ncer (CIBERONC), Madrid, 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Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Bargay","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario Son Llatzer, IdISBa (Institut d\u2019Investigaci\u00f3 Sanitaria Illes Balears), Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0565-9133","authenticated-orcid":false,"given":"Ana Pilar","family":"Gonzalez-Rodriguez","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario Central de Asturias, Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2423-822X","authenticated-orcid":false,"given":"Adri\u00e1n","family":"Alegre","sequence":"additional","affiliation":[{"name":"Hematology Department, University Hospital La Princesa & University Hospital QuironSalud, Autonoma-University, Madrid, 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Department, Hospital Cl\u00ednico Universitario Lozano Blesa, Instituto de Investigaci\u00f3n Sanitaria de Arag\u00f3n, Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6576-7881","authenticated-orcid":false,"given":"Miguel T.","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2969-3002","authenticated-orcid":false,"given":"Javier","family":"Lopez Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Ram\u00f3n y Cajal, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1859-9803","authenticated-orcid":false,"given":"Marta","family":"Reinoso-Segura","sequence":"additional","affiliation":[{"name":"Hematology Department, 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