Genomic profiling of smoldering multiple myeloma identifies patients at a high risk of disease progression
Open accessAbstract
PURPOSE: Smoldering multiple myeloma (SMM) is a precursor condition of multiple myeloma (MM) with a 10% annual risk of progression. Various prognostic models exist for risk stratification; however, those are based on solely clinical metrics. The discovery of genomic alterations that underlie disease progression to MM could improve current risk models. METHODS: We used next-generation sequencing to study 214 patients with SMM. We performed whole-exome sequencing on 166 tumors, including 5 with serial samples, and deep targeted sequencing on 48 tumors. RESULTS: We observed that most of the genetic alterations necessary for progression have already been acquired by the diagnosis of SMM. Particularly, we found that alterations of the mitogen-activated protein kinase pathway ( KRAS and NRAS single nucleotide variants [SNVs]), the DNA repair pathway (deletion 17p, TP53, and ATM SNVs), and MYC (translocations or copy number variations) were all independent risk factors of progression after accounting for clinical risk staging. We validated these findings in an external SMM cohort by showing that patients who have any of these three features have a higher risk of progressing to MM. Moreover, APOBEC associated mutations were enriched in patients who progressed and were associated with a shorter time to progression in our cohort. CONCLUSION: SMM is a genetically mature entity whereby most driver genetic alterations have already occurred, which suggests the existence of a right-skewed model of genetic evolution from monoclonal gammopathy of undetermined significance to MM. We identified and externally validated genomic predictors of progression that could distinguish patients at high risk of progression to MM and, thus, improve on the precision of current clinical models.
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RAS mutations, MYC translocations, APOBEC mutagenesis, and patterns of genomic complexity are the most commonly reported alterations in progressing multiple myeloma.
“Among these, RAS mutations, MYC translocations, APOBEC mutagenesis, and patterns of genomic complexity are the most commonly reported.8,9,11,69,76-83,84”
From Evolution of Multiple Myeloma from a Genomic Perspective (2026) · cites this paper as [78]
The sections on genomic predictors and mutational signatures link KRAS/NRAS mutations, MYC alterations (including translocations), and APOBEC mutagenesis to progression from smoldering multiple myeloma to multiple myeloma. The paper does not identify these four categories as the most commonly reported alterations, and the cited passages do not establish patterns of genomic complexity as a progression-associated category. Page numbers are not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredEither decreased efficacy of the immune system or selection of more aggressive and fit clones will eventually allow MGUS/SMM to progress into MM.
“Either the decreased efficacy of the immune system or the selection of more aggressive and fit clones will eventually allow the MGUS/SMM to progress into MM.76,78,79,104”
From Evolution of Multiple Myeloma from a Genomic Perspective (2026) · cites this paper as [78]
The Discussion (page unavailable) links genetic alterations and clonal expansion to a higher risk of SMM progression to MM, supporting the claim's clonal-selection component. The copy does not identify decreased immune-system efficacy as a mechanism, and the Introduction says some patients remain in an MGUS-like state for years rather than establishing that progression is inevitable. (LLM, conf=0.87)
Experimental — accuracy not yet measuredHigh-risk features are underrepresented among high-risk smoldering multiple myeloma (SMM) compared with newly diagnosed multiple myeloma (MM).
“Specifically, it is peculiar that these high-risk features are underrepresented among high-risk SMM compared to newly diagnosed MM.9,11,69,76-79”
From Evolution of Multiple Myeloma from a Genomic Perspective (2026) · cites this paper as [78]
The Genomic Landscape of SMM and Developing a Genomic Model for Prediction of Progression to MM (page unavailable) document genomic risk features in SMM and examine patients by clinical risk group. The copy does not show that those features are less prevalent in high-risk SMM than in newly diagnosed MM; its Discussion instead describes the two as having similar genetic makeup. (LLM, conf=0.78)
Experimental — accuracy not yet measured
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- Authors
- Bustoros, M., Sklavenitis-Pistofidis, R., Park, J., Redd, R., Zhitomirsky, B., Dunford, A. J., Salem, K., Tai, Y.-T., Anand, S., Mouhieddine, T. H., Chavda, S. J., Boehner, C., Elagina, L., Neuse, C. J., Cha, J., Rahmat, M., Taylor-Weiner, A., Van Allen, E., Kumar, S., Kastritis, E., Leshchiner, I., Morgan, E. A., Laubach, J., Casneuf, T., Richardson, P., Munshi, N. C., Anderson, K. C., Trippa, L., Aguet, F., Stewart, C., Dimopoulos, M.-A., Yong, K., Bergsagel, P. L., Manier, S., Getz, G., & Ghobrial, I. M.
- Affiliations
- Broad Institute (US)
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute (US)
- Harvard University (US)
- University College London (GB)
- Mayo Clinic (US)
- National and Kapodistrian University of Athens (GR)
- Brigham and Women's Hospital (US)
- Janssen (Belgium) (BE)
- Université de Lille (FR)
- Corresponding author
- Ghobrial, Irene M.
- ORCID
- Bustoros, Mark
- Park, Jihye
- Redd, Robert
- Zhitomirsky, Benny
- Dunford, Andrew J.
- Salem, Karma
- Tai, Yu-Tzu
- Anand, Shankara
- Mouhieddine, Tarek H.
- Chavda, Selina J.
- Boehner, Cody
- Neuse, Carl Jannes
- Cha, Justin
- Rahmat, Mahshid
- Taylor-Weiner, Amaro
- Kumar, Shaji
- Leshchiner, Ignaty
- Morgan, Elizabeth A.
- Laubach, Jacob
- Casneuf, Tineke
- Richardson, Paul
- Munshi, Nikhil C.
- Anderson, Kenneth C.
- Trippa, Lorenzo
- Aguet, François
- Stewart, Chip
- Dimopoulos, Meletios-Athanasios
- Yong, Kwee
- Bergsagel, P. Leif
- Manier, Salomon
- Getz, Gad
- Ghobrial, Irene M.
- Venue
- Journal of Clinical Oncology
- Published
- 2020-07-20
- Volume
- 38
- Issue
- 21
- Pages
- 2380-2389
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC7367550
- OpenAlex
- W3027407129
- Cited by
- 187
- References
- 10
- Citations by year
- 2026: 14 · 2025: 29 · 2024: 35 · 2023: 26 · 2022: 32 · 2021: 35 · 2020: 16
- FWCI
- 17.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Multiple Myeloma Research Foundation
- Leukemia and Lymphoma Society
- Dr. Miriam and Sheldon G. Adelson Medical Research Foundation
- Celgene
- European Hematology Association (TRTH177)
- Cancer Research UK
- National Institutes of Health
- Stand Up To Cancer
- Pharmacyclics
- National Human Genome Research Institute (T32HG002295)
- National Cancer Institute (R01CA195688, R01CA205954, R01CA168762, P50CA186781)
- Topics
- Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
- Health Sciences › Medicine › Genetics › Chronic Lymphocytic Leukemia Research
- Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
- Keywords
- smoldering multiple myeloma, progression to multiple myeloma, KRAS mutation, NRAS mutation, TP53 mutation, ATM mutations, 17p deletion, MYC translocation, MAPK signaling, DNA repair pathways, monoclonal gammopathy of undetermined significance, time to progression
- MeSH terms
- Smoldering Multiple Myeloma, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Risk Factors, Disease Progression, Genomics, High-Throughput Nucleotide Sequencing
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