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Predictors of progression in patients currently classified as SMM are not known. We identified 421 patients with SMM, diagnosed between 2003 and 2015. The median time to progression (TTP) was 57 months (CI, 45\u201372). BMPC% &gt;\u200920% [hazard ratio (HR): 2.28 (CI, 1.63\u20133.20); <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001]; M-protein &gt;\u20092g\/dL [HR: 1.56 (CI, 1.11\u20132.20); <jats:italic>p<\/jats:italic>\u2009=\u20090.01], and FLCr &gt;\u200920 [HR: 2.13 (CI, 1.55\u20132.93); <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001] independently predicted shorter TTP in multivariate analysis. Age and immunoparesis were not significant. We stratified patients into three groups: low risk (none of the three risk factors; <jats:italic>n<\/jats:italic>\u2009=\u2009143); intermediate risk (one of the three risk factors; <jats:italic>n<\/jats:italic>\u2009=\u2009121); and high risk (\u22652 of the three risk factors; <jats:italic>n<\/jats:italic>\u2009=\u2009153). The median TTP for low-, intermediate-, and high-risk groups were 110, 68, and 29 months, respectively (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). BMPC%\u2009&gt;\u200920%, M-protein\u2009&gt;\u20092\u2009g\/dL, and FLCr\u2009&gt;\u200920 at diagnosis can be used to risk stratify patients with SMM. Patients with high-risk SMM need close follow-up and are candidates for clinical trials aiming to prevent progression.<\/jats:p>","DOI":"10.1038\/s41408-018-0077-4","type":"journal-article","created":{"date-parts":[[2018,6,12]],"date-time":"2018-06-12T12:16:14Z","timestamp":1528805774000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":283,"title":["Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria"],"prefix":"10.1038","volume":"8","author":[{"given":"Arjun","family":"Lakshman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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M.A.G.\u2014Johnson and Johnson (honoraria). P.K.\u2014Takeda, Amgen, and Sanofi (research funding), and Celgene and Sanofi (consulting fees). Y.L.\u2014Janssen (research funding). S.K.K.\u2014Abbvie, Celgene, Janssen, Merck, Novartis, Roche, Sanofi, and Takeda (research funding), and Skyline Diagnostics (honoraria). The remaining authors declare that they have no conflict of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"59"}}