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This paper analyses the 133 (14%) patients who had previously known precursor disease including monoclonal gammopathy of undetermined significance (MGUS) and smouldering myeloma (SMM), reporting the relative importance of blood\u2010based biomarkers, imaging findings and symptoms in their management. Prior to progression with active myeloma, patients with precursor conditions had symptoms for five times longer than patients with no diagnosed precursor phase. Although only 29% of patients reported new myeloma\u2010related symptoms developing after their first haematology appointment, 70% had a significant rise in paraprotein levels prior to progression. Likewise, risk scores for both MGUS and SMM increased prior to progression. Fractures occurred in 25% of patients despite being monitored for precursor disease. These fractures were difficult to predict as biomarkers lacked specificity and only 40% of patients reported back pain in combination with vertebral fractures. This study highlights the ongoing challenge of promptly recognising disease progression when using patient\u2010reported symptoms and monoclonal immunoglobulin monitoring.<\/jats:p>","DOI":"10.1111\/bjh.70492","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T03:40:03Z","timestamp":1779334803000},"page":"2079-2086","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recognising disease progression in\n                    <scp>MGUS<\/scp>\n                    and smouldering myeloma: Biomarkers, symptom monitoring and imaging"],"prefix":"10.1111","volume":"208","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4975-3156","authenticated-orcid":false,"given":"Aidan","family":"Haslam","sequence":"first","affiliation":[{"name":"School of Biosciences, College of Life and Environmental Sciences University of Birmingham  Birmingham UK"},{"name":"Department of Haematology University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulnaz","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Drayson","sequence":"additional","affiliation":[{"name":"School of Infection, Inflammation and Immunology College of Medicine and Health  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Pratt","sequence":"additional","affiliation":[{"name":"Department of Haematology University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"},{"name":"School of Medical Sciences, College of Medicine and Health University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwee","family":"Yong","sequence":"additional","affiliation":[{"name":"University College London Cancer Institute University College London  London UK"},{"name":"Department of Haematology University College London Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Dunn","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0596-8515","authenticated-orcid":false,"given":"Catherine","family":"Atkin","sequence":"additional","affiliation":[{"name":"School of Infection, Inflammation and Immunology College of Medicine and Health  Birmingham UK"},{"name":"Department of Acute Medicine University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Bunce","sequence":"additional","affiliation":[{"name":"School of Biosciences, College of Life and Environmental Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Howe","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Bowcock","sequence":"additional","affiliation":[{"name":"Department of Haematology King's College Hospital NHS Foundation Trust  London UK"},{"name":"Faculty of Life Sciences and Medicine King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-016-0780-z"},{"key":"e_1_2_11_3_1","unstructured":"(HMRN) HMRN.Prevalence statistics 2025. 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