Smoldering Myeloma

What is smoldering myeloma?

Smoldering myeloma is an intermediate clinical stage of disease between MGUS and myeloma that has a much higher risk of progression to myeloma than MGUS (10% year or more).

It is defined as a serum monoclonal protein (IgG or IgA) >3g/dL or a urinary monoclonal protein >500 mg/24 h, and/or clonal bone marrow plasma cells between 10% and 60% AND the absence of any CRAB feature.

The early initiation of chemotherapy in this patient group may be considered to reduce the risk of organ damage by progression to myeloma.

4 Interesting Facts of Smoldering Myeloma

  1. Smoldering (indolent) myeloma has characteristics similar to those of monoclonal gammopathy of undetermined significance but may have more than 10% plasma cells in the bone marrow
  2. Both criteria must be met: 
    • Serum monoclonal protein (IgG or IgA) level of 3 g/dL or more or urinary monoclonal protein measurement of 500 mg or more per 24 hours and/or clonal marrow plasma cells 10% to 59%; and
    • Absence of myeloma-defining events or amyloidosis
  3. Obtain skeletal MRI or whole body PET-CT to distinguish multiple myeloma from smoldering myeloma
  4. Detection of 1 bone marrow lesion larger than 5 mm in diameter changes the status from smoldering myeloma to symptomatic myeloma requiring therapy

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