Smouldering myeloma

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Smouldering myeloma, also known as smoldering myeloma, indolent myeloma or asymptomatic myeloma, is a very slow-growing type of myeloma which is characterised by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein (M protein). Smouldering myeloma is a very early phase of myeloma and is devoid of symptoms but a bone marrow biopsy shows definite evidence of myeloma.


Smouldering myeloma is characterised by:

  • Serum paraprotein >30 g/L AND/OR
  • Clonal plasma cells >10% on bone marrow biopsy AND
  • No myeloma-related organ or tissue impairment


Smouldering myeloma with an increasingly abnormal serum free light chain (FLC) ratio is associated with a higher risk for progression to active multiple myeloma.[1]


Treatment for multiple myeloma is focused on therapies that decrease the clonal plasma cell population and consequently decrease the signs and symptoms of disease. If the disease is completely asymptomatic (i.e. there is a paraprotein and an abnormal bone marrow population but no end-organ damage), as in smoldering myeloma, treatment is typically deferred, or restricted to clinical trials.[2]

They are generally responsive to IL-1β neutralisation.[3]


  1. ^ Ballew, C; Liu, K; Savage, P; Oberman, A; Smoak, C (1990). "The utility of indirect measures of obesity in racial comparisons of blood pressure. CARDIA Study Group.". Journal of clinical epidemiology 43 (8): 799–804. doi:10.1182/blood-2007-08-108357. PMC 2200851. PMID 2200851. 
  2. ^ Korde N; Kristinsson SY; Landgren O (2011). "Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM): novel biological insights and development of early treatment strategies". Blood (journal) 117 (21): 5573–5581. doi:10.1182/blood-2011-01-270140. PMC 3316455. PMID 21441462. 
  3. ^ Dinarello CA (2011). "Interleukin-1 in the pathogenesis and treatment of inflammatory diseases". Blood 117 (14): 3720–32. doi:10.1182/blood-2010-07-273417. PMID 21304099. 

Further reading[edit]

  • Barlogie, B; van Rhee, F; Shaughnessy JD, Jr; Epstein, J; Yaccoby, S; Pineda-Roman, M; Hollmig, K; Alsayed, Y; Hoering, A; Szymonifka, J; Anaissie, E; Petty, N; Kumar, NS; Srivastava, G; Jenkins, B; Crowley, J; Zeldis, JB (Oct 15, 2008). "Seven-year median time to progression with thalidomide for smoldering myeloma: partial response identifies subset requiring earlier salvage therapy for symptomatic disease.". Blood 112 (8): 3122–5. doi:10.1182/blood-2008-06-164228. PMC 2569167. PMID 18669874. 
  • Pérez-Persona, E; Vidriales, MB; Mateo, G; García-Sanz, R; Mateos, MV; de Coca, AG; Galende, J; Martín-Nuñez, G; Alonso, JM; de Las Heras, N; Hernández, JM; Martín, A; López-Berges, C; Orfao, A; San Miguel, JF (Oct 1, 2007). "New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow plasma cells.". Blood 110 (7): 2586–92. doi:10.1182/blood-2007-05-088443. PMID 17576818. 
  • Kyle, RA; Durie, BG; Rajkumar, SV; Landgren, O; Blade, J; Merlini, G; Kröger, N; Einsele, H; Vesole, DH; Dimopoulos, M; San Miguel, J; Avet-Loiseau, H; Hajek, R; Chen, WM; Anderson, KC; Ludwig, H; Sonneveld, P; Pavlovsky, S; Palumbo, A; Richardson, PG; Barlogie, B; Greipp, P; Vescio, R; Turesson, I; Westin, J; Boccadoro, M; International Myeloma Working, Group (Jun 2010). "Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management.". Leukemia 24 (6): 1121–7. doi:10.1038/leu.2010.60. PMID 20410922. 
  • Dispenzieri, A; Kumar, S (Oct 31, 2013). "Treatment for high-risk smoldering myeloma.". The New England journal of medicine 369 (18): 1764. doi:10.1056/NEJMc1310911#SA3. PMID 24171529. 
  • "Treatment for High-Risk Smoldering Myeloma". New England Journal of Medicine 369 (18): 1762–1765. 31 October 2013. doi:10.1056/NEJMc1310911. 

External links[edit]