Smoldering multiple myeloma (SMM) is a precancerous condition that sits between MGUS and active multiple myeloma. It involves abnormal plasma cells and elevated M protein levels, but causes no symptoms — so many people don't even know they have it until it's picked up in routine blood tests. The risk of SMM progressing to Show Full Answer
Smoldering multiple myeloma (SMM) is a precancerous condition that sits between MGUS and active multiple myeloma. It involves abnormal plasma cells and elevated M protein levels, but causes no symptoms — so many people don't even know they have it until it's picked up in routine blood tests. The risk of SMM progressing to active myeloma decreases over time:
- First 5 years: about 10% chance per year
- Years 5–10: drops to around 3% per year
- After 10 years: roughly 1% per year
So the longer someone has SMM without progression, the lower their risk becomes. Certain factors can increase the risk of progression, including:
- High levels of plasma cells in the bone marrow
- Rising M protein levels over time
- Specific genetic changes in plasma cells
- Bone lesions showing up on imaging
- M protein made from IgA rather than IgG When it comes to managing SMM, there are a couple of approaches doctors may take. Traditionally, "watchful waiting" was the go-to — regular monitoring with no treatment, which helps avoid side effects. However, more recent evidence suggests that earlier treatment, especially for high-risk SMM, may actually improve outcomes.
Drugs like Revlimid (lenalidomide) and low-dose Decadron (dexamethasone) have shown promise in reducing the chances of progression for high-risk cases. Bisphosphonates may also be recommended to help protect bone health.
As always, it's worth having a detailed conversation with a specialist about which approach makes the most sense based on individual risk factors.
August 8
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