# Enhanced Risk Stratification of Smoldering Multiple Myeloma with Dynamic Biomarkers: A Multinational, Multicenter Study including 2,270 Participants (PANGEA 2.0)

## TL;DR

A new model called PANGEA 2.0 improves the prediction of when smoldering multiple myeloma will progress to active disease using dynamic biomarkers.

## Contribution

PANGEA 2.0 is the first model to use evolving biomarker trajectories for risk stratification in smoldering multiple myeloma.

## Key findings

- Four dynamic biomarkers were found to be significantly associated with progression from smoldering to active multiple myeloma.
- PANGEA 2.0 outperforms existing models in predicting progression with higher accuracy.
- The model is available as an open-access tool for clinical use and comparison with other models.

## Abstract

Accurate prediction of risk of progression from smoldering (SMM) to active multiple myeloma (MM) is paramount to individualized early therapeutic strategies with minimum risk of overtreatment. Current risk stratification models do not account for evolving biomarker trajectories. We assembled the largest cohort to date of 2,270 SMM patients from six international centers with longitudinal clinical and biological data to train and validate the PANGEA 2.0 risk models. Four evolving biomarkers were significantly associated with shorter time-to-progression: M-protein increase ≥0.2g/dL, involved:uninvolved serum free light chain ratio increase ≥20, creatinine increase >25%, and hemoglobin decrease ≥1.5g/dL. PANGEA 2.0 outperforms established models including the 20/2/20 and IMWG models by more accurately predicting progression (C-statistics=0.69–0.84), even without biomarker history (C-statistics=0.69–0.83) or recent bone marrow biopsy. PANGEA 2.0 is an easy-to-use, open-access tool (https://ghobrial.shinyapps.io/pangea_2_calculator) to improve and individualize SMM risk stratification. Validation tools are available to compare PANGEA 2.0 to established models (https://ghobrial.shinyapps.io/pangea_validation).