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The risk of progression to symptomatic myeloma (<jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content>) varies greatly among individuals diagnosed with myeloma precursor disease. Epidemiologic, molecular, flow cytometric and radiological techniques have demonstrated that this transformation to <jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> from precursor states is not sudden but rather a continuous overlapping series of events with evidence of end\u2010organ damage that could manifest in the earliest stages of disease. Contemporary antimyeloma therapies can yield rapid, deep, and durable responses with manageable toxicities, and molecular\u2010cell\u2010based measures are now available to rule out minimal residual disease. 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