Smoldering Multiple Myeloma Overview

A precursor stage of active multiple myeloma (MM), smoldering multiple myeloma (SMM) is characterized by abnormal plasma cells in the bone marrow and an increased level of an antibody known as monoclonal protein (M protein) in the blood. Even so, SMM does not produce typical MM symptoms.

Smoldering multiple myeloma does not always progress into active multiple myeloma. In the first five years after diagnosis, approximately 10% of individuals with SMM develop MM each year. The risk drops to 3% per year for the next five years and 1% per year thereafter.

What causes smoldering multiple myeloma?

SMM occurs when healthy plasma cells undergo harmful changes that cause them to grow uncontrollably and produce excessive amounts of M protein, which can thicken the blood and build up in the body. The precise genetic alterations and mechanisms behind the progression from healthy plasma cells to SMM are complex. Scientists believe the process may involve various oncogenes and tumor suppressor genes.

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What are the risk factors for smoldering multiple myeloma?

Risk factors for smoldering multiple myeloma include:

• Advanced age – Most SMM cases are diagnosed after age 70.
• Another plasma cell disorder – Individuals diagnosed with monoclonal gammopathy of undetermined significance (MGUS) are at heightened risk for developing SMM.
• Family history – Individuals who have one or more close relatives who were diagnosed with MGUS or MM are at increased risk.

The known risk factors for smoldering multiple myeloma cannot be controlled. However, by adopting a healthy lifestyle, it may be possible to reduce the risk of SMM progressing into MM. General recommendations include:

• Eating a healthy diet – Most individuals should aim for a balanced intake of fruits, vegetables, whole grains, lean proteins and healthy fats while limiting consumption of processed foods, added sugars and excessive salt and saturated fats.
• Exercising regularly – Engaging in regular physical activity is essential for maintaining overall good health and strengthening the immune system.
• Avoiding tobacco use and excessive alcohol consumption – Smoking and heavy drinking are linked to many types of cancer, including MM.
• Having regular health screenings – Keeping up with routine medical checkups and recommended screening tests can help ensure that any issues are detected early and addressed promptly.

What are the signs and symptoms of smoldering multiple myeloma?

SMM is an early, asymptomatic stage of MM. However, patients who are diagnosed with smoldering multiple myeloma may be monitored for signs of progression to active multiple myeloma, which can include:

• Bone pain
• Fatigue
• Frequent infections
• Anemia
• Kidney dysfunction

How is smoldering multiple myeloma diagnosed?

The diagnostic process for SMM usually includes blood work and/or urinalysis to check for elevated levels of plasma cells and M protein.

How is smoldering multiple myeloma treated?

Because SMM does not cause symptoms, it is usually closely monitored rather than actively treated. This approach, which is known as "watchful waiting" or "active surveillance," involves regular medical checkups with blood and urine testing to monitor the progression of the condition. If smoldering multiple myeloma progresses to active multiple myeloma, treatment options may include chemotherapy, targeted therapy, immunotherapy and/or bone marrow transplantation.

Benefit from world-class care at Moffitt Cancer Center

Moffitt’s Malignant Hematology Program is dedicated to the prevention, early detection and effective treatment of all forms of hematologic cancer, including multiple myeloma. Our multispecialty team is available to share prevention strategies, provide educational information about MM symptoms and offer individualized guidance to individuals who are at risk due to a smoldering multiple myeloma diagnosis. For those who are diagnosed with active multiple myeloma, Moffitt offers the most advanced treatment options available, including a robust portfolio of clinical trials.

If you would like to learn more about smoldering multiple myeloma, you can request an appointment with a specialist in our Malignant Hematology Program by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.