Table of ContentsView AllTable of ContentsSignsCausesDiagnosisRisk of ProgressionOngoing MonitoringTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Signs
Causes
Diagnosis
Risk of Progression
Ongoing Monitoring
Treatment
Coping
Smolderingmyelomais a rare, pre-cancerous condition involving abnormal proteins and increased plasma cells in thebone marrow. It is called “smoldering” because it doesn’t produce symptoms, but also doesn’t resolve. It slowly worsens over time, eventually leading to severe complications.
Though sometimes called smoldering multiple myeloma (SMM), this condition is not the same asmultiple myeloma(MM), a rare blood cancer. However, in some cases, SMM can turn into MM.Anyone diagnosed with SMM should be evaluated for this risk.
This article looks at possible signs, causes, and complications of smoldering myeloma. It also discusses the risk of progression, treatments, and how to cope.
Alex Raths / Getty Images
Smoldering Myeloma Symptoms
Smoldering myeloma is an asymptomatic condition, meaning you will not notice any signs or symptoms that hint you have it. The main sign of SMM—the presence of a myeloma (M) protein in the blood—is only identified with bloodwork.
Multiple myeloma may not cause symptoms early on, so this test result can come as a surprise. When MM does cause symptoms, they can include frequent infections, bone pain, kidney problems, and anemia, which might also prompt testing that reveals the diagnosis.
How Your Immune System Works
Complications
While it lacks earlier symptoms, over time, high levels of M-protein in your blood can cause severe complications, such as:
Nerve damage:Peripheral neuropathy, nerve damage that causes numbness or tingling in the feet or hands, is a common complication associated with M-protein.
Compromised immune system: While this condition leads to high antibody levels, the antibodies produced don’t work right and overtake healthy cells. This leads to an impaired immune system and frequent infections.
Proper treatment can lower your chances of developing these complications.
Causes and Risk Factors
No one really knows what causes smoldering myeloma or multiple myeloma. Experts suspect several causal and risk factors are at play:
Most of the time, smoldering myeloma is diagnosed accidentally, when abnormal lab tests show up during aroutine physicalor when your healthcare provider is investigating a different medical condition.
Lab findings for SMM may include:
Part of the diagnostic of smoldering myeloma is also:
Absence of lytic lesions, anemia, hypercalcemia, and kidney impairment (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 with involved FLC >100 mg/dL; or more than one focal bone lesion on magnetic resonance imaging [MRI]).
While people with smoldering myeloma are at risk of developing multiple myeloma, the risk drops over time:
Determining your risk of multiple myeloma is important for treatment purposes. A 2017 study revealed evidence that early treatment of high-risk cases helped people live longer.
Those at low to intermediate risk of progression are not treated due to the potential for severe side effects.
If you are high-risk, you’re a candidate for immediate treatment aimed at slowing the progression of the disease and keeping you symptom-free.
Determining Your Risk Level
To identify who’s most at risk of smoldering myeloma progressing to multiple myeloma, healthcare providers rely on guidelines set out in the3-risk-factor model, or2/20/20 risk stratification.
Tests are done to check bone marrow plasma cells, M-protein levels, and free light chains—immune system proteins that function as antibodies.
One point is given for every result indicating an elevated risk of disease progression two years from diagnosis:
Points are interpreted as follows:
Healthcare providers may also use the4-risk-factor model, which adds the presence of genetic abnormalities believed to play a role in MM into the equation. The scoring is similar:
Your score in either of these models translates to the following risk of developing multiple myeloma two years after a smoldering myeloma diagnosis:
Ongoing Monitoring of Smoldering Myeloma
Once you’re diagnosed with SMM, you will continue to be monitored to see if the disease is progressing to MM. It’s recommended that people with SMM be evaluated every four months, but those evaluations may be increased to every six months.
Diagnostic tests often used for ongoing observation of SMM may include:
Smoldering Myeloma Treatment
Right now, multiple myeloma can’t be cured, so prevention is paramount. That’s why high-risk people with SMM should be treated.
Treatment of smoldering myeloma typically involves:
Ongoing research aims to determine what early treatments are most effective at preventing SMM progression.
What Is Multiple Myeloma?
Coping With SMM
Being diagnosed with smoldering myeloma can be emotionally challenging. It’s natural to fear that this pre-cancerous condition will progress to cancer, especially if you’re at higher risk.
If you’re having trouble coping with your fears or suspect you are clinically depressed, talk to your healthcare provider about mental health counseling.
Summary
SMM is a pre-cancerous condition that may progress to a blood cancer called multiple myeloma and cause serious health problems such as kidney damage, bone disorders, and an impaired immune system.
Healthcare providers determine your risk of SMM progressing to multiple myeloma based on the results of lab tests. People at high risk generally start treatment to prevent or delay multiple myeloma. This involves chemotherapy drugs or newer anti-cancer medication.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institutes of Health, National Cancer Institute.Drug shows promise in slowing progression of smoldering myeloma to cancer.Bianchi G, Ghobrial IM.Does my patient with a serum monoclonal spike have multiple myeloma?.Hematol Oncol Clin North Am. 2012;26(2):383-93, ix. doi:10.1016/j.hoc.2012.02.009Multiple Myeloma Research Foundation.Symptoms and Side Effects.Koura DT, Langston AA.Inherited predisposition to multiple myeloma.Ther Adv Hematol.2013;4(4):291-7. doi:10.1177/2040620713485375Rajkumar SV, Landgren O, Mateos MV.Smoldering multiple myeloma.Blood. 2015;125(20):3069-3075. doi:10.1182%2Fblood-2014-09-568899Multiple Myeloma Research Foundation.Early treatment of smoldering multiple myeloma.Muchtar E, Kumar SK, Magen H, Gertz MA.Diagnosis and management of smoldering multiple myeloma: the razor’s edge between clonality and cancer.Leukemia and Lymphoma.2018 Feb;59(2):288-299. doi:10.1080/10428194.2017.1334124Mateos MV, Kumar S, Dimopoulos MA, et al.International Myeloma Working Group risk stratification model for smoldering multiple myeloma (Smm). Blood Cancer J. 2020;10(10):102.Visram A, Cook J, Warsame R.Smoldering multiple myeloma: evolving diagnostic criteria and treatment strategies.Hematology. 2021;2021(1):673-681. doi:10.1182/hematology.2021000304Multiple Myeloma Research Foundation.Standard Treatments.Musto P, La Rocca F.Monoclonal antibodies in newly diagnosed and smoldering multiple myeloma: an updated review of current clinical evidence.Expert Rev Hematol. 2020;13(5):501-517. doi:10.1080/17474086.2020.1753502Additional ReadingRajkumar SV, Dimopoulos MA, Palumbo A, et al.International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma.The Lancet.2014 Nov;15(12):e538-48. doi:10.1016/S1470-2045(14)70442-5
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institutes of Health, National Cancer Institute.Drug shows promise in slowing progression of smoldering myeloma to cancer.Bianchi G, Ghobrial IM.Does my patient with a serum monoclonal spike have multiple myeloma?.Hematol Oncol Clin North Am. 2012;26(2):383-93, ix. doi:10.1016/j.hoc.2012.02.009Multiple Myeloma Research Foundation.Symptoms and Side Effects.Koura DT, Langston AA.Inherited predisposition to multiple myeloma.Ther Adv Hematol.2013;4(4):291-7. doi:10.1177/2040620713485375Rajkumar SV, Landgren O, Mateos MV.Smoldering multiple myeloma.Blood. 2015;125(20):3069-3075. doi:10.1182%2Fblood-2014-09-568899Multiple Myeloma Research Foundation.Early treatment of smoldering multiple myeloma.Muchtar E, Kumar SK, Magen H, Gertz MA.Diagnosis and management of smoldering multiple myeloma: the razor’s edge between clonality and cancer.Leukemia and Lymphoma.2018 Feb;59(2):288-299. doi:10.1080/10428194.2017.1334124Mateos MV, Kumar S, Dimopoulos MA, et al.International Myeloma Working Group risk stratification model for smoldering multiple myeloma (Smm). Blood Cancer J. 2020;10(10):102.Visram A, Cook J, Warsame R.Smoldering multiple myeloma: evolving diagnostic criteria and treatment strategies.Hematology. 2021;2021(1):673-681. doi:10.1182/hematology.2021000304Multiple Myeloma Research Foundation.Standard Treatments.Musto P, La Rocca F.Monoclonal antibodies in newly diagnosed and smoldering multiple myeloma: an updated review of current clinical evidence.Expert Rev Hematol. 2020;13(5):501-517. doi:10.1080/17474086.2020.1753502Additional ReadingRajkumar SV, Dimopoulos MA, Palumbo A, et al.International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma.The Lancet.2014 Nov;15(12):e538-48. doi:10.1016/S1470-2045(14)70442-5
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Institutes of Health, National Cancer Institute.Drug shows promise in slowing progression of smoldering myeloma to cancer.Bianchi G, Ghobrial IM.Does my patient with a serum monoclonal spike have multiple myeloma?.Hematol Oncol Clin North Am. 2012;26(2):383-93, ix. doi:10.1016/j.hoc.2012.02.009Multiple Myeloma Research Foundation.Symptoms and Side Effects.Koura DT, Langston AA.Inherited predisposition to multiple myeloma.Ther Adv Hematol.2013;4(4):291-7. doi:10.1177/2040620713485375Rajkumar SV, Landgren O, Mateos MV.Smoldering multiple myeloma.Blood. 2015;125(20):3069-3075. doi:10.1182%2Fblood-2014-09-568899Multiple Myeloma Research Foundation.Early treatment of smoldering multiple myeloma.Muchtar E, Kumar SK, Magen H, Gertz MA.Diagnosis and management of smoldering multiple myeloma: the razor’s edge between clonality and cancer.Leukemia and Lymphoma.2018 Feb;59(2):288-299. doi:10.1080/10428194.2017.1334124Mateos MV, Kumar S, Dimopoulos MA, et al.International Myeloma Working Group risk stratification model for smoldering multiple myeloma (Smm). Blood Cancer J. 2020;10(10):102.Visram A, Cook J, Warsame R.Smoldering multiple myeloma: evolving diagnostic criteria and treatment strategies.Hematology. 2021;2021(1):673-681. doi:10.1182/hematology.2021000304Multiple Myeloma Research Foundation.Standard Treatments.Musto P, La Rocca F.Monoclonal antibodies in newly diagnosed and smoldering multiple myeloma: an updated review of current clinical evidence.Expert Rev Hematol. 2020;13(5):501-517. doi:10.1080/17474086.2020.1753502
National Institutes of Health, National Cancer Institute.Drug shows promise in slowing progression of smoldering myeloma to cancer.
Bianchi G, Ghobrial IM.Does my patient with a serum monoclonal spike have multiple myeloma?.Hematol Oncol Clin North Am. 2012;26(2):383-93, ix. doi:10.1016/j.hoc.2012.02.009
Multiple Myeloma Research Foundation.Symptoms and Side Effects.
Koura DT, Langston AA.Inherited predisposition to multiple myeloma.Ther Adv Hematol.2013;4(4):291-7. doi:10.1177/2040620713485375
Rajkumar SV, Landgren O, Mateos MV.Smoldering multiple myeloma.Blood. 2015;125(20):3069-3075. doi:10.1182%2Fblood-2014-09-568899
Multiple Myeloma Research Foundation.Early treatment of smoldering multiple myeloma.
Muchtar E, Kumar SK, Magen H, Gertz MA.Diagnosis and management of smoldering multiple myeloma: the razor’s edge between clonality and cancer.Leukemia and Lymphoma.2018 Feb;59(2):288-299. doi:10.1080/10428194.2017.1334124
Mateos MV, Kumar S, Dimopoulos MA, et al.International Myeloma Working Group risk stratification model for smoldering multiple myeloma (Smm). Blood Cancer J. 2020;10(10):102.
Visram A, Cook J, Warsame R.Smoldering multiple myeloma: evolving diagnostic criteria and treatment strategies.Hematology. 2021;2021(1):673-681. doi:10.1182/hematology.2021000304
Multiple Myeloma Research Foundation.Standard Treatments.
Musto P, La Rocca F.Monoclonal antibodies in newly diagnosed and smoldering multiple myeloma: an updated review of current clinical evidence.Expert Rev Hematol. 2020;13(5):501-517. doi:10.1080/17474086.2020.1753502
Rajkumar SV, Dimopoulos MA, Palumbo A, et al.International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma.The Lancet.2014 Nov;15(12):e538-48. doi:10.1016/S1470-2045(14)70442-5
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