Asymptomatic (smoldering) myeloma: treatment strategy

SUMMARY Smoldering multiple myeloma (SMM) is an asymptomatic plasma cell disorder that requires no treatment until progression occurs. Several trials have been conducted in SMM patients to delay the time to progression to symptomatic disease but these yielded no clear benefit. However, the risk of progression to symptomatic disease is not uniform. Several markers have been identified and, overall, these factors identify patients who have a 50% probability of progression after 2 years. The aforementioned trials were conducted in SMM patients without stratification according to risk. A randomized trial including only high-risk SMM patients has recently been carried out, showing a significant benefit of early treatment with lenalidomide plus dexamethasone.