{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:44:38Z","timestamp":1790109878611,"version":"4.0.1"},"reference-count":92,"publisher":"American Society of Hematology","issue":"8","license":[{"start":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T00:00:00Z","timestamp":1652659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/legalcode"}],"content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,8,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The current standard of care in smoldering multiple myeloma (SMM) is close surveillance, outside of clinical trials. Efforts are being made to understand the pathobiologic process that leads to the progression of SMM to active MM. This review provides a critical description of available data, including risk factors and risk models of progression, as well as clinical trials investigating interventions for this patient population. We describe 2 cases in which patients were seen before the concept of a myeloma-defining event was established. Today, based on the International Myeloma Working Group criteria, both patients would have been identified as experiencing myeloma-defining events, and therapy would have been initiated. These cases show that occasionally, patients can undergo observation only, even when they exceed criteria for high-risk SMM.<\/jats:p>","DOI":"10.1182\/blood.2021011670","type":"journal-article","created":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T20:03:35Z","timestamp":1652731415000},"page":"828-838","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":28,"title":["How I approach smoldering multiple myeloma"],"prefix":"10.1182","volume":"140","author":[{"given":"Iuliana","family":"Vaxman","sequence":"first","affiliation":[{"name":"1Division of Hematology, Mayo Clinic, Rochester, MN;"},{"name":"2Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel; and"},{"name":"3Department of Hematology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3853-5196","authenticated-orcid":false,"given":"Morie A.","family":"Gertz","sequence":"additional","affiliation":[{"name":"1Division of Hematology, Mayo Clinic, Rochester, MN;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"24","key":"2022082515223440900_B1","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1056\/NEJM198006123022405","article-title":"Smoldering multiple myeloma","volume":"302","author":"Kyle","year":"1980","journal-title":"N Engl J Med."},{"issue":"3","key":"2022082515223440900_B2","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1182\/blood.V56.3.521.521","article-title":"Localized and indolent myeloma","volume":"56","author":"Alexanian","year":"1980","journal-title":"Blood."},{"issue":"1","key":"2022082515223440900_B3","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1182\/blood.V62.1.166.166","article-title":"Clinical, morphological, and cell kinetic differences among multiple myeloma, monoclonal gammopathy of undetermined significance, and smoldering multiple myeloma","volume":"62","author":"Greipp","year":"1983","journal-title":"Blood."},{"issue":"12","key":"2022082515223440900_B4","doi-asserted-by":"crossref","first-page":"e538","DOI":"10.1016\/S1470-2045(14)70442-5","article-title":"International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma","volume":"15","author":"Rajkumar","year":"2014","journal-title":"Lancet Oncol."},{"issue":"25","key":"2022082515223440900_B5","doi-asserted-by":"crossref","first-page":"2582","DOI":"10.1056\/NEJMoa070389","article-title":"Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma","volume":"356","author":"Kyle","year":"2007","journal-title":"N Engl J Med."},{"issue":"7","key":"2022082515223440900_B6","doi-asserted-by":"crossref","first-page":"2586","DOI":"10.1182\/blood-2007-05-088443","article-title":"New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow plasma cells","volume":"110","author":"P\u00e9rez-Persona","year":"2007","journal-title":"Blood."},{"issue":"2","key":"2022082515223440900_B7","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1182\/blood-2007-08-108357","article-title":"Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma","volume":"111","author":"Dispenzieri","year":"2008","journal-title":"Blood."},{"issue":"6","key":"2022082515223440900_B8","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1038\/s41408-018-0077-4","article-title":"Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria","volume":"8","author":"Lakshman","year":"2018","journal-title":"Blood Cancer J."},{"issue":"10","key":"2022082515223440900_B9","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.3109\/10428194.2013.764419","article-title":"Modeling progression risk for smoldering multiple myeloma: results from a prospective clinical study","volume":"54","author":"Cherry","year":"2013","journal-title":"Leuk Lymphoma."},{"issue":"1","key":"2022082515223440900_B10","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1001\/jamaoncol.2020.5585","article-title":"Assessment of discordance among smoldering multiple myeloma risk models","volume":"7","author":"Hill","year":"2021","journal-title":"JAMA Oncol."},{"key":"2022082515223440900_B11","doi-asserted-by":"crossref","first-page":"4760","DOI":"10.1182\/blood-2019-121786","article-title":"Population-level trends in early mortality and overall survival of patients with multiple myeloma. 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