Priority 13 from the Myeloma (Canada) PSP

UNCERTAINTY: What are new ways to monitor and/or treat the initial stages of myeloma (e.g. MGUS and smoldering myeloma) to delay or prevent the development of active myeloma?  (JLA PSP Priority 13)
Overall ranking 13
JLA question ID 0113/13
Explanatory note Monoclonal gammopathy of undetermined significance (MGUS) is a condition in which patients have M-protein present in their blood, but do not have multiple myeloma. Approximately 1% of patients with MGUS will develop myeloma each year. Smoldering myeloma is an early, asymptomatic form of myeloma before the onset of active disease. Participants wanted to see new ways to monitor and treat (e.g., chemotherapy, stem cell transplant) these precursors and prevent the development of active myeloma.  
Evidence

No evidence identified 
Health Research Classification System category Cancer and neoplasms
Extra information provided by this PSP
Original uncertainty examples Can smouldering myeloma be treated to prevent or delay it from becoming active? ~ Should people who have been diagnosed with MGUS start active therapy? ~ Can treatment start when you are MGUS or smouldering?  ~ Will treating smouldering myeloma slow the progression of the disease? ~ I would like to know how early MGUS can be detected in a person. ~ It seems better to track the MGUS, as it may go on to being SMM AND then active myeloma. ~ Is there an advantage to adjuvant chemotherapy in the treatment of solitary plasmacytoma, MGUS & smouldering MM that will prevent disease progression to systemic/active myeloma?  
Submitted by Please see the PSP Engagement Summary on the JLA website  
PSP information
PSP unique ID 0113
PSP name Myeloma (Canada)
Total number of uncertainties identified by this PSP. 59  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 28 April 2021