{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:58:46Z","timestamp":1771462726743,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T00:00:00Z","timestamp":1621987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background\u2014smoldering multiple myeloma (SMM) risk of progression to multiple myeloma (MM) is highly heterogeneous and several models have been suggested to predict this risk. Lakshman et al. recently proposed a model based on three biomarkers: bone marrow plasma cell (BMPC) percentage &gt; 20%, free light chain ratio (FLCr) &gt; 20 and serum M protein &gt; 20 g\/L. The goal of our study was to test this \u201c20\/20\/20\u201d model in our population and to determine if similar results could be obtained in another cohort of SMM patients. Method\u2014we conducted a retrospective, single center study with 89 patients diagnosed with SMM between January 2008 and December 2019. Results\u2014all three tested biomarkers were associated with an increased risk of progression: BMPC percentage \u2265 20% (hazard ratio [HR]: 4.28 [95%C.I., 1.90\u20139.61]; p &lt; 0.001), serum M protein \u2265 20 g\/L (HR: 4.20 [95%C.I., 1.90\u201315.53]; p = 0.032) and FLCr \u2265 20 (HR: 3.25 [95%C.I., 1.09\u20139.71]; p = 0.035). The estimated median time to progression (TTP) was not reached for the low and intermediate risk groups and was 29.1 months (95%C.I., 3.9\u201354.4) in the high-risk group (p = 0.006). Conclusions\u2014the 20\/20\/20 risk stratification model adequately predicted progression in our population and is easy to use in various clinical settings.<\/jats:p>","DOI":"10.3390\/curroncol28030188","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T10:30:32Z","timestamp":1622025032000},"page":"2029-2039","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Testing Mayo Clinic\u2019s New 20\/20\/20 Risk Model in Another Cohort of Smoldering Myeloma Patients: A Retrospective Study"],"prefix":"10.3390","volume":"28","author":[{"given":"Camille","family":"Tessier","sequence":"first","affiliation":[{"name":"Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC J1H 5H3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Allard","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC J1H 5H3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Samuel","family":"Boudreault","sequence":"additional","affiliation":[{"name":"H\u00f4pital Universitaire du Sacr\u00e9-C\u0153ur de Montr\u00e9al, Montreal, QC H4J 1C5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rayan","family":"Kaedbey","sequence":"additional","affiliation":[{"name":"Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"\u00c9thier","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC J1H 5H3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fl\u00e9ch\u00e8re","family":"Fortin","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC J1H 5H3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7057-7492","authenticated-orcid":false,"given":"Michel","family":"Pavic","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC J1H 5H3, Canada"},{"name":"Centre de Recherche du CHUS (CRCHUS), Sherbrooke, QC J1H 5N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,26]]},"reference":[{"key":"ref_1","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."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"21","DOI":"10.2147\/BLCTT.S136447","article-title":"Smoldering multiple myeloma: Prevalence and current evidence guiding treatment decisions","volume":"8","author":"Blum","year":"2018","journal-title":"Blood Lymphat. Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e486","DOI":"10.1038\/bcj.2016.100","article-title":"Prevalence, incidence and survival of smoldering multiple myeloma in the United States","volume":"6","author":"Ravindran","year":"2016","journal-title":"Blood Cancer J."},{"key":"ref_4","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."},{"key":"ref_5","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."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1038\/leu.2012.309","article-title":"Extensive bone marrow infiltration and abnormal free light chain ratio identifies patients with asymptomatic myeloma at high risk for progression to symptomatic disease","volume":"27","author":"Kastritis","year":"2013","journal-title":"Leukemia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4172","DOI":"10.1182\/blood-2013-08-520890","article-title":"Smoldering multiple myeloma requiring treatment: Time for a new definition?","volume":"122","author":"Dispenzieri","year":"2013","journal-title":"Blood"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"He, Y., Wheatley, K., Clark, O., Glasmacher, A., Ross, H., and Djulbegovic, B. (2003). Early versus deferred treatment for early stage multiple myeloma. Cochrane Database Syst. Rev., CD004023.","DOI":"10.1002\/14651858.CD004023"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1054\/bjoc.1999.1087","article-title":"Long-term survival of stage I multiple myeloma given chemotherapy just after diagnosis or at progression of the disease: A multicentre randomized study. Cooperative Group of Study and Treatment of Multiple Myeloma","volume":"82","author":"Riccardi","year":"2000","journal-title":"Br. J. Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/j.1600-0609.1993.tb00148.x","article-title":"Initial versus deferred melphalan-prednisone therapy for asymptomatic multiple myeloma stage I\u2014A randomized study. Myeloma Group of Western Sweden","volume":"50","author":"Hjorth","year":"1993","journal-title":"Eur. J. Haematol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3772","DOI":"10.1158\/1078-0432.CCR-18-3470","article-title":"Randomized, Double-Blind, Placebo-Controlled, Multicenter Study of Siltuximab in High-Risk Smoldering Multiple Myeloma","volume":"25","author":"Brighton","year":"2019","journal-title":"Clin. Cancer Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/S1470-2045(16)30124-3","article-title":"Lenalidomide plus dexamethasone versus observation in patients with high-risk smouldering multiple myeloma (QuiRedex): Long-term follow-up of a randomised, controlled, phase 3 trial","volume":"17","author":"Mateos","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1200\/JCO.19.01740","article-title":"Randomized Trial of Lenalidomide Versus Observation in Smoldering Multiple Myeloma","volume":"38","author":"Lonial","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_14","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."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/s41408-020-00366-3","article-title":"International Myeloma Working Group risk stratification model for smoldering multiple myeloma (SMM)","volume":"10","author":"Mateos","year":"2020","journal-title":"Blood Cancer J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3149","DOI":"10.1182\/bloodadvances.2018024794","article-title":"Plasma cell proliferative index is an independent predictor of progression in smoldering multiple myeloma","volume":"2","author":"Aljama","year":"2018","journal-title":"Blood Adv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1038\/s41375-018-0013-4","article-title":"Evolving M-protein pattern in patients with smoldering multiple myeloma: Impact on early progression","volume":"32","author":"Isola","year":"2018","journal-title":"Leukemia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2026","DOI":"10.1038\/leu.2016.123","article-title":"Bence Jones proteinuria in smoldering multiple myeloma as a predictor marker of progression to symptomatic multiple myeloma","volume":"30","author":"Davila","year":"2016","journal-title":"Leukemia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1038\/leu.2012.296","article-title":"Serum free light chain ratio as a biomarker for high-risk smoldering multiple myeloma","volume":"27","author":"Larsen","year":"2013","journal-title":"Leukemia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1158\/1078-0432.CCR-10-1066","article-title":"The progression from MGUS to smoldering myeloma and eventually to multiple myeloma involves a clonal expansion of genetically abnormal plasma cells","volume":"17","author":"Gutierrez","year":"2011","journal-title":"Clin. Cancer Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1002\/ajh.24319","article-title":"Clinical characteristics and outcomes in biclonal gammopathies","volume":"91","author":"Mullikin","year":"2016","journal-title":"Am. J. Hematol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4325","DOI":"10.1200\/JCO.2012.48.4923","article-title":"Progression in smoldering myeloma is independently determined by the chromosomal abnormalities del(17p), t(4;14), gain 1q, hyperdiploidy, and tumor load","volume":"31","author":"Neben","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_23","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":"Vidriales","year":"2007","journal-title":"Blood"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1038\/leu.2013.86","article-title":"Impact of primary molecular cytogenetic abnormalities and risk of progression in smoldering multiple myeloma","volume":"27","author":"Rajkumar","year":"2013","journal-title":"Leukemia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1046\/j.1365-2141.2003.04654.x","article-title":"Smoldering multiple myeloma: Natural history and recognition of an evolving type","volume":"123","author":"Rosinol","year":"2003","journal-title":"Br. J. Haematol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s00277-010-1028-8","article-title":"Asymptomatic immunoglobulin light chain amyloidosis (AL) at the time of diagnostic bone marrow biopsy in newly diagnosed patients with multiple myeloma and smoldering myeloma. A series of 144 cases and a review of the literature","volume":"90","author":"Siragusa","year":"2011","journal-title":"Ann. Hematol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1016\/S2352-3026(14)70001-8","article-title":"Clinical course of light-chain smouldering multiple myeloma (idiopathic Bence Jones proteinuria): A retrospective cohort study","volume":"1","author":"Kyle","year":"2014","journal-title":"Lancet Haematol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2188","DOI":"10.1002\/cncr.24959","article-title":"Beta-2-microglobulin is an independent predictor of progression in asymptomatic multiple myeloma","volume":"116","author":"Rossi","year":"2010","journal-title":"Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3379","DOI":"10.1182\/blood.V124.21.3379.3379","article-title":"Predictive Significance of Serum Beta 2-Microglobulin Levels and M-Protein Velocity for Symptomatic Progression of Smoldering Multiple Myeloma","volume":"124","author":"Muta","year":"2014","journal-title":"Blood"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/ejh.12728","article-title":"Smoldering multiple myeloma risk factors for progression: A Danish population-based cohort study","volume":"97","author":"Sorrig","year":"2016","journal-title":"Eur. J. Haematol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/bjh.16572","article-title":"Identification of patients with smouldering multiple myeloma at ultra-high risk of progression using serum parameters: The Czech Myeloma Group model","volume":"190","author":"Hajek","year":"2020","journal-title":"Br. J. Haematol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1038\/s41375-019-0634-2","article-title":"Cytogenetic subclone formation and evolution in progressive smoldering multiple myeloma","volume":"34","author":"Merz","year":"2020","journal-title":"Leukemia"}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/28\/3\/188\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:08:03Z","timestamp":1760162883000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/28\/3\/188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,26]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["curroncol28030188"],"URL":"https:\/\/doi.org\/10.3390\/curroncol28030188","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,26]]}}}