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Smoldering multiple myeloma

S Vincent Rajkumar, MD
Section Editor
Robert A Kyle, MD
Deputy Editor
Rebecca F Connor, MD


Smoldering multiple myeloma (SMM) is diagnosed in persons who meet the following criteria (table 1) [1]:

Serum monoclonal protein ≥3 g/dL and/or 10 to 60 percent bone marrow clonal plasma cells

Absence of lytic lesions, anemia, hypercalcemia, and renal insufficiency (end-organ damage) that can be attributed to the plasma cell proliferative disorder and the absence of biomarkers associated with near inevitable progression to end-organ damage (≥60 percent clonal plasma cells in the marrow; involved/uninvolved free light chain (FLC) ratio of 100 or more; or more than one focal bone lesion on magnetic resonance imaging [MRI])

SMM is distinguished from multiple myeloma (MM) based upon the lack of end-organ damage; it is distinguished from monoclonal gammopathy of undetermined significance (MGUS) based on the size of the M protein and the percent plasma cells in the bone marrow (algorithm 1 and table 2).

The clinical course and management of patients with SMM will be discussed here. The diagnosis of this and other plasma cell dyscrasias, the recognition of serum or urinary monoclonal proteins, and the management of symptomatic MM are presented separately. (See "Overview of the management of multiple myeloma" and "Clinical features, laboratory manifestations, and diagnosis of multiple myeloma" and "Diagnosis of monoclonal gammopathy of undetermined significance" and "Clinical course and management of monoclonal gammopathy of undetermined significance" and "Laboratory methods for analyzing monoclonal proteins".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 22, 2016.
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