How We Approach Smoldering Multiple Myeloma

Abstract

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.

FIG 1.

(A) Bone marrow aspirate, (B) serum protein electrophoresis (SPEP) and immunofixation, and (C) positron emission tomography–computed tomography (PET-CT) from a patient with smoldering multiple myeloma. The SPEP and immunofixation show an immunoglobulin G lambda monoclonal protein measuring 4.52 g/dL. The bone marrow aspirate had 26% plasma cells. PET-CT was negative for [¹⁸F]fluorodeoxyglucose-avid bone lesions. By the 20/2/20 criteria, this patient has high-risk smoldering multiple myeloma.