Smoldering Multiple Myeloma: A New Story to Tell

Smoldering Multiple Myeloma (SMM) is characterized by an M spike of 3 g/dL or more and/or a bone marrow containing at least 10% plasma cells with no evidence of end organ damage. Historically management of SMM patients has been based on a “watch and wait” strategy, but after understanding the heterogeneity of the behavior of this disease, several objections have been raised regarding need to start a therapy in some patients. The identification of several risk factors associated with a risk of progression of approximately 80% within 2 years of diagnosis, has allowed the identification of a small sub-category of SMM patients who gain benefit from early treatment. However, for all other patients, to date, a no-intervention approach is still recommended outside clinical trials. In this review, we provide an overview of SMM including definitions, current diagnostic work-up, risk factors associated with progression, and data from clinical trials performed with the objective of providing early treatment to SMM patients.