Fig. 1: Approach to the management of smoldering multiple myeloma.
From: Smoldering multiple myeloma current treatment algorithms
Footnote for Fig. 1: SMM, smoldering multiple myeloma; MM, multiple myeloma; Rd, lenalidomide plus dexamethasone. Myeloma Defining Events: End organ damage felt to be related to myeloma (hypercalcemia, light chain cast nephropathy, anemia, osteolytic bone lesions), serum free light chain ratio ≥100 with involved serum free light chain level ≥100 mg/dL and urine monoclonal protein ≥200 mg per 24 h on urine protein electrophoresis, ≥60% clonal bone marrow plasma cells, >1 focal lesion on magnetic resonance imaging. High risk Smoldering Multiple Myeloma: Any 2 of the following: bone marrow plasma cells >20%, serum monoclonal protein >2 gm/dL, serum free light chain ratio >20. Or high risk score based on the International Myeloma Working Group Scoring System for Smoldering Multiple Myeloma. Evolving change: Increase in monoclonal protein of 0.5 gm/dl or more along with a concomitant decrease in hemoglobin of 0.5 g/dl or more over a 12-month period.
