{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T22:52:03Z","timestamp":1789944723687,"version":"4.0.1"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2016,2,26]],"date-time":"2016-02-26T00:00:00Z","timestamp":1456444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100005026","name":"Belgian Foundation Against Cancer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005026","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fonds de la Recherche Scientifique M\u00e9dicale"},{"name":"Fonds National de la Recherche Scientifique"},{"name":"Fonds sp\u00e9ciaux de la Recherche"},{"DOI":"10.13039\/501100005627","name":"Universit\u00e9 de Li\u00e8ge","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005627","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Deutsche Krebshilfe Grant","award":["111424"],"award-info":[{"award-number":["111424"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder and bridges monoclonal gammopathy of undetermined significance to multiple myeloma (MM), based on higher levels of circulating monoclonal immunoglobulin and bone marrow plasmocytosis without end-organ damage. Until a Spanish study reported fewer MM-related events and better overall survival among patients with high-risk SMM treated with lenalidomide and dexamethasone, prior studies had failed to show improved survival with earlier intervention, although a reduction in skeletal-related events (without any impact on disease progression) has been described with bisphosphonate use. Risk factors have now been defined, and a subset of ultra-high-risk patients have been reclassified by the International Myeloma Working Group as MM, and thus will require optimal MM treatment, based on biomarkers that identify patients with a &amp;gt;80% risk of progression. The number of these redefined patients is small (\u223c10%), but important to unravel, because their risk of progression to overt MM is substantial (\u226580% within 2 years). Patients with a high-risk cytogenetic profile are not yet considered for early treatment, because groups are heterogeneous and risk factors other than cytogenetics are deemed to weight higher. Because patients with ultra-high-risk SMM are now considered as MM and may be treated as such, concerns exist that earlier therapy may increase the risk of selecting resistant clones and induce side effects and costs. Therefore, an even more accurate identification of patients who would benefit from interventions needs to be performed, and clinical judgment and careful discussion of pros and cons of treatment initiation need to be undertaken. For the majority of SMM patients, the standard of care remains observation until development of symptomatic MM occurs, encouraging participation in ongoing and upcoming SMM\/early MM clinical trials, as well as consideration of bisphosphonate use in patients with early bone loss.<\/jats:p>","DOI":"10.1634\/theoncologist.2015-0303","type":"journal-article","created":{"date-parts":[[2016,2,27]],"date-time":"2016-02-27T03:59:38Z","timestamp":1456545578000},"page":"333-342","source":"Crossref","is-referenced-by-count":27,"title":["The Changing Landscape of Smoldering Multiple Myeloma: A European Perspective"],"prefix":"10.1093","volume":"21","author":[{"given":"Jo","family":"Caers","sequence":"first","affiliation":[{"name":"a Department of Hematology, University Hospital of Li\u00e8ge, Li\u00e8ge, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Fern\u00e1ndez de Larrea","sequence":"additional","affiliation":[{"name":"b Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Cl\u00ednic and Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Leleu","sequence":"additional","affiliation":[{"name":"c Hopital La Miletrie, CHU Poitiers, Poitiers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Heusschen","sequence":"additional","affiliation":[{"name":"d Hematology Laboratory, Groupe Interdisciplinaire de G\u00e9noprot\u00e9omique Appliqu\u00e9e-I3, University of Li\u00e8ge, Li\u00e8ge, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Zojer","sequence":"additional","affiliation":[{"name":"e Department of Medicine I, Wilhelminen Hospital, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Decaux","sequence":"additional","affiliation":[{"name":"f Internal Medicine Department, Rennes University Hospitals, H\u00f4pital Sud, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efstathios","family":"Kastritis","sequence":"additional","affiliation":[{"name":"g Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"Minnema","sequence":"additional","affiliation":[{"name":"h Department of Haematology, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Jurczyszyn","sequence":"additional","affiliation":[{"name":"i Department of Hematology Jagiellonian University, Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"Beguin","sequence":"additional","affiliation":[{"name":"a Department of Hematology, University Hospital of Li\u00e8ge, Li\u00e8ge, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"W\u00e4sch","sequence":"additional","affiliation":[{"name":"j Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Palumbo","sequence":"additional","affiliation":[{"name":"k Myeloma Unit, Divisione di Ematologia dell\u2019Universit\u00e0 di Torino, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meletios","family":"Dimopoulos","sequence":"additional","affiliation":[{"name":"g Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Victoria","family":"Mateos","sequence":"additional","affiliation":[{"name":"l Instituto de Investigaci\u00f3n Biom\u00e9dica de Salamanca\u2013Hematology, Hospital Universitario de Salamanca, Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz","family":"Ludwig","sequence":"additional","affiliation":[{"name":"e Department of Medicine I, Wilhelminen Hospital, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Engelhardt","sequence":"additional","affiliation":[{"name":"j Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,2,26]]},"reference":[{"key":"2021122703520610200_B1","doi-asserted-by":"crossref","first-page":"232","DOI":"10.3324\/haematol.2013.099358","article-title":"European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple 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