Smouldering multiple myeloma (SMM) is stratified into standard-, intermediate-, and high-risk categories. The management pathway is determined by this risk classification, and the appropriate approach differs meaningfully between groups.
Patients with standard- or intermediate-risk SMM do not require immediate therapy. High-risk SMM represents a distinct population for whom the clinical situation calls for a different management strategy, and participation in investigational studies is actively recommended.
The structured protocol describes the evidence-based recommendation for each risk group. The approach for lower-risk patients centres on a defined monitoring strategy, while the management of high-risk SMM addresses options beyond that standard pathway — including the current status of approved therapies in this setting. The full protocol specifies how risk category shapes every step.
Patients with standard- or intermediate-risk smouldering MM (SMM; see Supplementary Table S4, available at https://doi.org/10.1016/j.annonc.2020.11.014) do not need immediate therapy.
'Watch-and-wait' remains the recommended approach for SMM [II, B].
To date, no treatment has been approved for SMM.
High-risk patients are encouraged to participate in randomised phase III studies that are powered for OS advantage of the experimental treatment modality.
DOI: 10.1016/j.annonc.2020.11.014
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