Smoldering Multiple Myeloma Treatment

Smoldering multiple myeloma (SMM) is an early, asymptomatic stage of multiple myeloma (MM), a blood cancer that affects the antibody-producing white blood cells (plasma cells) in the bone marrow. In MM, abnormal plasma cells multiply uncontrollably, crowding out healthy blood cells and producing abnormal proteins. This can lead to anemia, kidney problems, recurrent infections, weakened bones and other complications.

In SMM, abnormal plasma cells may accumulate in the bone marrow, or monoclonal protein (M protein) levels may rise in the blood, but the typical symptoms of active MM are absent. The condition is often discovered incidentally during routine blood work performed for an unrelated reason.

The exact cause of smoldering multiple myeloma is not fully understood. Research suggests that certain genetic mutations, along with risk factors such as advanced age and a family history of MM or monoclonal gammopathy of undetermined significance (MGUS), may contribute to its development. SMM is most frequently diagnosed in adults 60 and older, affecting slightly more men than women.

Active surveillance for smoldering multiple myeloma

Because SMM does not cause symptoms or immediate complications, it is usually managed through careful observation rather than immediate treatment. Typically, the patient will be closely monitored for any signs that the condition is progressing toward active multiple myeloma. In a high-risk case, early intervention might be considered, but for most patients, active surveillance remains the standard of care. This wait-and-watch strategy can delay treatment until necessary, helping the patient avoid unneeded therapies and the associated side effects.

What does active surveillance for smoldering multiple myeloma involve?

Usually, active surveillance for SMM involves periodic medical evaluations, which may include:

• Blood work
• Bone marrow biopsy
• Imaging
• Urinalysis

These tests can help the physician track the levels of plasma cells in the bone marrow and M protein in the blood. Visits may be scheduled every three to six months, depending on the patient’s risk profile and lab results. If any signs of SMM progression are detected, a treatment plan will be discussed promptly.

What are the potential benefits of active surveillance for smoldering multiple myeloma?

The main advantage of active surveillance for SMM is that it can allow the patient to avoid the risks and side effects of early cancer treatment while maintaining careful medical oversight. Many people with smoldering multiple myeloma remain stable for years without requiring therapy. By postponing treatment until it becomes clinically necessary, the patient can preserve their quality of life and reduce or delay potential complications from chemotherapy, radiation therapy or other interventions. Active surveillance can also enable early detection of disease progression, when therapy is often most effective.

What are the possible side effects of active surveillance for smoldering multiple myeloma?

Active surveillance does not require medications or invasive procedures, so it carries no physical side effects. However, this wait-and-watch approach can affect the patient emotionally. For example, some patients may experience anxiety or stress related to the uncertainty of disease progression or the regular monitoring schedule. Ongoing communication with the healthcare team and access to emotional support can help the patient manage these concerns.

Benefit from world-class care at Moffitt Cancer Center

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