{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T04:21:25Z","timestamp":1773807685786,"version":"3.50.1"},"reference-count":97,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,6]],"date-time":"2024-07-06T00:00:00Z","timestamp":1720224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Monoclonal antibodies (MoAbs) targeting several cellular receptors have significantly improved the prognosis of multiple myeloma (MM). Their high effectiveness and safety raise the question of whether earlier therapeutic intervention in monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) influences the natural course of the disease. MM is preceded by clinically recognized conditions such as MGUS and SMM. Numerous studies are investigating the disease biology and immune profile of SMM and MGUS to unravel the intricate relationship between immunosurveillance and disease progression. The standard approach to MGUS and SMM remains close observation. Early studies indicate benefits in terms of progression or even survival for promptly treating high-risk SMM patients. Ongoing debates are focused on which patients with SMM and MGUS to treat, as well as on determining the optimal therapeutic approach. The first approach aims to cure by attempting to eliminate the pathological clone, while the second approach is preventive, aiming to manage disease progression to active MM and restore the immune system. In this review, we focus on the available and emerging data on early treatment, particularly with MoAbs alone or in combination with other therapies, in SMM and MGUS patients.<\/jats:p>","DOI":"10.3390\/ph17070901","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T14:40:50Z","timestamp":1720449650000},"page":"901","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Monoclonal Antibodies in Smoldering Multiple Myeloma and Monoclonal Gammopathy of Undetermined Significance: Current Status and Future Directions"],"prefix":"10.3390","volume":"17","author":[{"given":"Valeria","family":"Ferla","sequence":"first","affiliation":[{"name":"Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5124-6970","authenticated-orcid":false,"given":"Francesca","family":"Farina","sequence":"additional","affiliation":[{"name":"Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Perini","sequence":"additional","affiliation":[{"name":"Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"},{"name":"Age Related Diseases Laboratory, Division of Genetics and Cell Biology, IRCSS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magda","family":"Marcatti","sequence":"additional","affiliation":[{"name":"Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Ciceri","sequence":"additional","affiliation":[{"name":"Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"},{"name":"Faculty of Medicine and Surgery, Vita-Salute IRCCS San Raffaele University, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1038\/leu.2013.313","article-title":"Continued improvement in survival in multiple myeloma: Changes in early mortality and outcomes in older patients","volume":"28","author":"Kumar","year":"2014","journal-title":"Leukemia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/bjh.15121","article-title":"Current use of monoclonal antibodies in the treatment of multiple myeloma","volume":"181","author":"Varga","year":"2018","journal-title":"Br. J. Haematol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1080\/14712598.2020.1717464","article-title":"Antibody therapies for multiple myeloma","volume":"20","author":"Gavriatopoulou","year":"2020","journal-title":"Expert Opin. Biol. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0140-6736(19)31240-1","article-title":"Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): A randomised, open-label, phase 3 study","volume":"394","author":"Moreau","year":"2019","journal-title":"Lancet"},{"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":"3069","DOI":"10.1182\/blood-2014-09-568899","article-title":"Smoldering multiple myeloma","volume":"125","author":"Rajkumar","year":"2015","journal-title":"Blood"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1056\/NEJMoa1300439","article-title":"Lenalidomide plus Dexamethasone for High-Risk Smoldering Multiple Myeloma","volume":"369","author":"Mateos","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_8","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_9","doi-asserted-by":"crossref","first-page":"3045","DOI":"10.1182\/bloodadvances.2018021220","article-title":"Timing of treatment of smoldering myeloma: Early treatment","volume":"2","author":"Mateos","year":"2018","journal-title":"Blood Adv."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5412","DOI":"10.1182\/blood-2008-12-194241","article-title":"Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: A prospective study","volume":"113","author":"Landgren","year":"2009","journal-title":"Blood"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5418","DOI":"10.1182\/blood-2008-12-195008","article-title":"A monoclonal gammopathy precedes multiple myeloma in most patients","volume":"113","author":"Weiss","year":"2009","journal-title":"Blood"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1056\/NEJMoa054494","article-title":"Prevalence of Monoclonal Gammopathy of Undetermined Significance","volume":"354","author":"Kyle","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1016\/S0140-6736(10)60482-5","article-title":"Prevalence and risk of progression of light-chain monoclonal gammopathy of undetermined significance: A retrospective population-based cohort study","volume":"375","author":"Dispenzieri","year":"2010","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2617","DOI":"10.1182\/blood-2009-01-198788","article-title":"The importance of bone marrow examination in determining complete response to therapy in patients with multiple myeloma","volume":"114","author":"Chee","year":"2009","journal-title":"Blood"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1056\/NEJMoa01133202","article-title":"A Long-Term Study of Prognosis in Monoclonal Gammopathy of Undetermined Significance","volume":"346","author":"Kyle","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1056\/NEJMoa1709974","article-title":"Long-Term Follow-up of Monoclonal Gammopathy of Undetermined Significance","volume":"378","author":"Kyle","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1373\/clinchem.2015.253740","article-title":"Comprehensive Assessment of M-Proteins Using Nanobody Enrichment Coupled to MALDI-TOF Mass Spectrometry","volume":"62","author":"Mills","year":"2016","journal-title":"Clin. Chem."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1021\/pr400985k","article-title":"Using Mass Spectrometry to Monitor Monoclonal Immunoglobulins in Patients with a Monoclonal Gammopathy","volume":"13","author":"Barnidge","year":"2014","journal-title":"J. Proteome Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/s41408-019-0263-z","article-title":"Detection and prevalence of monoclonal gammopathy of undetermined significance: A study utilizing mass spectrometry-based monoclonal immunoglobulin rapid accurate mass measurement","volume":"9","author":"Murray","year":"2019","journal-title":"Blood Cancer J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e195","DOI":"10.1016\/j.clml.2023.02.004","article-title":"Monoclonal Gammopathy of Undetermined Significance: A Comprehensive Review","volume":"23","author":"Kaur","year":"2023","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1038\/s41591-022-02183-6","article-title":"Prevalence of smoldering multiple myeloma based on nationwide screening","volume":"29","author":"Aspelund","year":"2023","journal-title":"Nat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1182\/blood.V96.6.2037","article-title":"Solitary plasmacytoma of bone and asymptomatic multiple myeloma","volume":"96","author":"Dimopoulos","year":"2000","journal-title":"Blood"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/0002-9343(93)90120-E","article-title":"Risk of disease progression in asymptomatic multiple myeloma","volume":"94","author":"Dimopoulos","year":"1993","journal-title":"Am. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1056\/NEJMoa1300439","article-title":"Treatment for High-Risk Smoldering Myeloma","volume":"369","author":"Mateos","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/ajh.23204","article-title":"Preventive strategies in monoclonal gammopathy of undetermined significance and smoldering multiple myeloma","volume":"87","author":"Rajkumar","year":"2012","journal-title":"Am. J. Hematol."},{"key":"ref_26","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_27","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1182\/blood-2005-03-1038","article-title":"Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance","volume":"106","author":"Rajkumar","year":"2005","journal-title":"Blood"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1182\/blood-2013-05-505487","article-title":"Monoclonal gammopathy of undetermined significance and risk of lymphoid and myeloid malignancies: 728 cases followed up to 30 years in Sweden","volume":"123","author":"Turesson","year":"2014","journal-title":"Blood"},{"key":"ref_29","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_30","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/j.1365-2141.2009.07929.x","article-title":"Risk of progression in smouldering myeloma and monoclonal gammopathies of unknown significance: Comparative analysis of the evolution of monoclonal component and multiparameter flow cytometry of bone marrow plasma cells","volume":"148","author":"Mateo","year":"2010","journal-title":"Br. J. Haematol."},{"key":"ref_31","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"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1182\/blood-2013-07-515239","article-title":"Clinical, genomic, and imaging predictors of myeloma progression from asymptomatic monoclonal gammopathies (SWOG S0120)","volume":"123","author":"Dhodapkar","year":"2014","journal-title":"Blood"},{"key":"ref_33","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_34","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_35","doi-asserted-by":"crossref","first-page":"945","DOI":"10.4065\/mcp.2010.0520","article-title":"Advances in the Diagnosis, Classification, Risk Stratification, and Management of Monoclonal Gammopathy of Undetermined Significance: Implications for Recategorizing Disease Entities in the Presence of Evolving Scientific Evidence","volume":"85","author":"Rajkumar","year":"2010","journal-title":"Mayo Clin. Proc."},{"key":"ref_36","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_37","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_38","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":"Esteve","year":"2003","journal-title":"Br. J. Haematol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1038\/leu.2012.237","article-title":"High levels of peripheral blood circulating plasma cells as a specific risk factor for progression of smoldering multiple myeloma","volume":"27","author":"Bianchi","year":"2013","journal-title":"Leukemia"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1200\/JCO.2009.25.5356","article-title":"Prognostic Significance of Focal Lesions in Whole-Body Magnetic Resonance Imaging in Patients with Asymptomatic Multiple Myeloma","volume":"28","author":"Hillengass","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3835","DOI":"10.1038\/s41467-019-11680-1","article-title":"Genomic landscape and chronological reconstruction of driver events in multiple myeloma","volume":"10","author":"Maura","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3363","DOI":"10.1038\/s41467-018-05058-y","article-title":"Genomic patterns of progression in smoldering multiple myeloma","volume":"9","author":"Bolli","year":"2018","journal-title":"Nat. Commun."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1182\/blood-2015-10-662320","article-title":"Immune status of high-risk smoldering multiple myeloma patients and its therapeutic modulation under LenDex: A longitudinal analysis","volume":"127","author":"Paiva","year":"2016","journal-title":"Blood"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.ccr.2005.10.012","article-title":"TGF-\u03b2 directly targets cytotoxic T cell functions during tumor evasion of immune surveillance","volume":"8","author":"Thomas","year":"2005","journal-title":"Cancer Cell"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1038\/s41375-020-0810-4","article-title":"Daratumumab induces mechanisms of immune activation through CD38+ NK cell targeting","volume":"35","author":"Viola","year":"2021","journal-title":"Leukemia"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1038\/leu.2010.60","article-title":"Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management","volume":"24","author":"Kyle","year":"2010","journal-title":"Leukemia"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"984","DOI":"10.3324\/haematol.2013.100552","article-title":"The clinical relevance and management of monoclonal gammopathy of undetermined significance and related disorders: Recommendations from the European Myeloma Network","volume":"99","author":"Palumbo","year":"2014","journal-title":"Haematologica"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2397","DOI":"10.1001\/jama.2010.1713","article-title":"Multiple Myeloma Precursor Disease","volume":"304","author":"Landgren","year":"2010","journal-title":"JAMA"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.hoc.2014.06.005","article-title":"Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma","volume":"28","author":"Kyle","year":"2014","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s11899-013-0174-1","article-title":"New Approaches to Smoldering Myeloma","volume":"8","author":"Mateos","year":"2013","journal-title":"Curr. Hematol. Malign Rep."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1038\/s41408-022-00719-0","article-title":"Smoldering multiple myeloma current treatment algorithms","volume":"12","author":"Rajkumar","year":"2022","journal-title":"Blood Cancer J."},{"key":"ref_52","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","volume":"50","author":"Hjorth","year":"1993","journal-title":"Eur. J. Haematol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1038\/bjc.1996.212","article-title":"A prognostic index for multiple myeloma","volume":"73","author":"Grignani","year":"1996","journal-title":"Br. J. Cancer"},{"key":"ref_54","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","volume":"82","author":"Riccardi","year":"2000","journal-title":"Br. J. Cancer"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1038\/leu.2012.236","article-title":"A phase III randomized trial of thalidomide plus zoledronic acid versus zoledronic acid alone in patients with asymptomatic multiple myeloma","volume":"27","author":"Witzig","year":"2013","journal-title":"Leukemia"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1038\/sj.leu.2402866","article-title":"Thalidomide as initial therapy for early-stage myeloma","volume":"17","author":"Rajkumar","year":"2003","journal-title":"Leukemia"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1200\/JCO.2003.03.139","article-title":"Thalidomide Alone or With Dexamethasone for Previously Untreated Multiple Myeloma","volume":"21","author":"Weber","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"771","DOI":"10.3109\/10428194.2011.553000","article-title":"Pamidronate versus observation in asymptomatic myeloma: Final results with long-term follow-up of a randomized study","volume":"52","author":"Gobbi","year":"2011","journal-title":"Leuk. Lymphoma"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1002\/cncr.23783","article-title":"A multicenter, randomized clinical trial comparing zoledronic acid versus observation in patients with asymptomatic myeloma","volume":"113","author":"Musto","year":"2008","journal-title":"Cancer"},{"key":"ref_60","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_61","unstructured":"Mateos, M.V., Hernandez, M.T., and Salvador, C. (2020, January 11\u201321). Over ten years of follow-up for phase II trial in smoldering myeloma at high risk of progression to myeloma: Sustained TTP and OS benefit with RD versus no treatment. Proceedings of the 25th EHA Congress, European Hematology Association, The Hague, The Netherlands."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"8001","DOI":"10.1200\/JCO.2019.37.15_suppl.8001","article-title":"E3A06: Randomized phase Ill trial of lena- lidomide versus observation alone in patients with asymptomatic high-risk smol- dering multiple myeloma","volume":"37","author":"Lonial","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.hoc.2023.12.001","article-title":"Smoldering Multiple Myeloma: Observation Versus Control Versus Cure","volume":"38","author":"Rajkumar","year":"2024","journal-title":"Hematol. Clin. N. Am."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1038\/ki.2015.201","article-title":"Bortezomib produces high hematological response rates with prolonged renal survival in monoclonal immunoglobulin deposition disease","volume":"88","author":"Cohen","year":"2015","journal-title":"Kidney Int."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1007\/s00277-018-3572-6","article-title":"Bortezomib-based chemotherapy can improve renal and tubular functions in patients with light chain-associated Fanconi syndrome","volume":"98","author":"Wu","year":"2019","journal-title":"Ann. Hematol."},{"key":"ref_66","first-page":"402","article-title":"Curative Strategy for High-Risk Smoldering Myeloma (GEM-CESAR): Carlfizomib, Lenalidomide and Dexamethasone (KRd) As Induction Followed By HDT- ASCT, Consolidation with Krd and Maintenance with Rd","volume":"130","author":"Mateos","year":"2017","journal-title":"Blood"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1038\/s41375-020-0718-z","article-title":"Daratumumab monotherapy for patients with intermediate-risk or high-risk smoldering multiple myeloma: A randomized, open-label, multicenter, phase 2 study (CENTAURUS)","volume":"34","author":"Landgren","year":"2020","journal-title":"Leukemia"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.1001\/jamaoncol.2021.3971","article-title":"Carfilzomib, Lenalidomide, and Dexamethasone Followed by Lenalidomide Maintenance for Prevention of Symptomatic Multiple Myeloma in Patients with High-risk Smoldering Myeloma","volume":"7","author":"Kazandjian","year":"2021","journal-title":"JAMA Oncol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1182\/blood-2023-181765","article-title":"Efficacy and Safety of Daratumumab (DARA) Monotherapy in Patients with Intermediate-Risk or High-Risk Smoldering Multiple Myeloma (SMM): Final Analysis of the Phase 2 Centaurus Study","volume":"142","author":"Landgren","year":"2023","journal-title":"Blood"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"TPS8075","DOI":"10.1200\/JCO.2022.40.16_suppl.TPS8075","article-title":"Subcutaneous daratumumab (DARA SC) versus active monitoring in patients (pts) with high-risk smoldering multiple myeloma (SMM): Randomized, open-label, phase 3 AQUILA study","volume":"40","author":"Dimopoulos","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"8040","DOI":"10.1200\/JCO.2022.40.16_suppl.8040","article-title":"B-PRISM (Precision Intervention Smoldering Myeloma): A phase II trial of combination of daratumumab, bortezomib, lenalidomide, and dexamethasone in high-risk smoldering multiple myeloma","volume":"40","author":"Nadeem","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1182\/blood-2020-142584","article-title":"Aggressive Smoldering Curative Approach Evaluating Novel Therapies (ASCENT): A Phase 2 Trial of Induction, Consolidation and Maintenance in Subjects with High Risk Smoldering Multiple Myeloma (SMM): Initial Analysis of Safety Data","volume":"136","author":"Kumar","year":"2020","journal-title":"Blood"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1182\/blood-2022-168930","article-title":"Fixed Duration Therapy with Daratumumab, Carfilzomib, Lenalidomide and Dexamethasone for High Risk Smoldering Multiple Myeloma-Results of the Ascent Trial","volume":"140","author":"Kumar","year":"2022","journal-title":"Blood"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"3116","DOI":"10.1182\/blood-2019-123205","article-title":"A Multicenter Phase II Single Arm Trial of Isatuximab in Patients with High Risk Smoldering Multiple Myeloma (HRSMM)","volume":"134","author":"Manasanch","year":"2019","journal-title":"Blood"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"7317","DOI":"10.1182\/blood-2022-157302","article-title":"Isatuximab in Combination with Lenalidomide and Dexamethasone in Patients with High-Risk Smoldering Multiple Myeloma: Updated Safety Run-in Results from the Randomized Phase 3 Ithaca Study","volume":"140","author":"Mateos","year":"2022","journal-title":"Blood"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/bjh.15384","article-title":"Elotuzumab monotherapy in patients with smouldering multiple myeloma: A phase 2 study","volume":"182","author":"Jagannath","year":"2018","journal-title":"Br. J. Haematol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1182\/blood-2018-154","article-title":"Phase 2 trial of combination of elotuzumab, lenalidomide and dexamethasone for high-risk smoldering multiple myeloma","volume":"132","author":"Liu","year":"2018","journal-title":"Blood"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2400","DOI":"10.1182\/bloodadvances.2019000300","article-title":"A pilot study of pembrolizumab in smoldering myeloma: Report of the clinical, immune, and genomic analysis","volume":"3","author":"Manasanch","year":"2019","journal-title":"Blood Adv."},{"key":"ref_79","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_80","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1007\/s12325-020-01601-w","article-title":"Evaluation of Cardiac Repolarization in the Randomized Phase 2 Study of Intermediate- or High-Risk Smoldering Multiple Myeloma Patients Treated with Daratumumab Monotherapy","volume":"38","author":"Chari","year":"2021","journal-title":"Adv. Ther."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1007\/s00262-013-1493-8","article-title":"Elotuzumab directly enhances NK cell cytotoxicity against myeloma via CS1 ligation: Evidence for augmented NK cell function complementing ADCC","volume":"62","author":"Collins","year":"2013","journal-title":"Cancer Immunol. Immunother."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1056\/NEJMoa1505654","article-title":"Elotuzumab Therapy for Relapsed or Refractory Multiple Myeloma","volume":"373","author":"Lonial","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Bar, N., Costa, F., Das, R., Duffy, A., Samur, M., McCachren, S., Gettinger, S.N., Neparidze, N., Parker, T.L., and Bailur, J.K. (2020). Differential effects of PD-L1 versus PD-1 blockade on myeloid inflammation in human cancer. J. Clin. Investig., 5.","DOI":"10.1172\/jci.insight.129353"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"8008","DOI":"10.1200\/JCO.2018.36.15_suppl.8008","article-title":"FDA analysis of pembrolizumab trials in multiple myeloma: Immune related adverse events (irAEs) and response","volume":"36","author":"Krauss","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1006\/cbir.2000.0497","article-title":"Role of interleukin-6 in the pathogenesis of multiple myeloma","volume":"24","author":"Hegyesi","year":"2000","journal-title":"Cell Biol. Int."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1182\/blood-2019-129103","article-title":"A Phase II Study of Daratumumab in Patients with High-Risk MGUS and Low-Risk Smoldering Multiple Myeloma: First Report of Efficacy and Safety","volume":"134","author":"Nadeem","year":"2019","journal-title":"Blood"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1111\/bjh.17052","article-title":"Daratumumab-based therapy for patients with monoclonal gammopathy of renal significance","volume":"193","author":"Kastritis","year":"2021","journal-title":"Br. J. Haematol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1681\/ASN.2020101541","article-title":"Safety and Efficacy of Daratumumab in Patients with Proliferative GN with Monoclonal Immunoglobulin Deposits","volume":"32","author":"Zand","year":"2021","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Bolli, N., Sgherza, N., Curci, P., Rizzi, R., Strafella, V., Delia, M., Gagliardi, V.P., Neri, A., Baldini, L., and Albano, F. (2021). What Is New in the Treatment of Smoldering Multiple Myeloma?. J. Clin. Med., 10.","DOI":"10.3390\/jcm10030421"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1182\/hematology.2021000304","article-title":"Smoldering multiple myeloma: Evolving diagnostic criteria and treatment strategies","volume":"2021","author":"Visram","year":"2021","journal-title":"Hematology"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2799","DOI":"10.3324\/haematol.2021.278519","article-title":"2021 European Myeloma Network review and consensus statement on smoldering multiple myeloma: How to distinguish (and manage) Dr. Jekyll and Mr. Hyde","volume":"106","author":"Musto","year":"2021","journal-title":"Haematologica"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"101144","DOI":"10.1016\/j.beha.2020.101144","article-title":"Second malignancies in multiple myeloma; emerging patterns and future directions","volume":"33","author":"Maclachlan","year":"2020","journal-title":"Best Pract. Res. Clin. Haematol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1093\/annonc\/mdx160","article-title":"Second primary malignancies in multiple myeloma: An overview and IMWG consensus","volume":"29","author":"Musto","year":"2018","journal-title":"Ann. Oncol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"100757","DOI":"10.1016\/j.blre.2020.100757","article-title":"Second primary malignancies in multiple myeloma: A review","volume":"46","author":"Poh","year":"2021","journal-title":"Blood Rev."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1038\/s41375-018-0153-6","article-title":"Multiple myeloma clonal evolution in homogeneously treated patients","volume":"32","author":"Corre","year":"2018","journal-title":"Leukemia"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1038\/nrclinonc.2013.160","article-title":"Haematological cancer: Treatment of smoldering multiple myeloma","volume":"10","author":"Rajkumar","year":"2013","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"2793","DOI":"10.1080\/10428194.2021.1938032","article-title":"The landscape of trials for smoldering multiple myeloma: Endpoints, trial design, and lessons learnt","volume":"62","author":"Mohyuddin","year":"2021","journal-title":"Leuk. 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