[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-459939-105":59,"doc-detail-459939-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","navigating-the-evolving-management-of-smoldering-multiple-myeloma-review-article","Navigating the evolving management of smoldering multiple myeloma - Review Article","","Smoldering multiple myeloma (SMM) is an intermediate clinical stage between MGUS and symptomatic multiple myeloma, with highly variable risk of progression. Effective care depends on individualized risk stratification. Earlier models used static tumor-burden markers but did not reflect biological heterogeneity. Recent approaches incorporate dynamic biomarkers, cytogenetics, and genomic profiling, emphasizing immune dysregulation and subclonal evolution. Clinical trials increasingly test early therapy for high-risk SMM, while clinicians weigh overtreatment versus therapeutic delay. This review traces SMM’s shift from a clinical entity to a biologically defined precursor state and highlights tools to improve prediction and outcomes.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/navigating-the-evolving-management-of-smoldering-multiple-myeloma-review-article/459939/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/navigating-the-evolving-management-of-smoldering-multiple-myeloma-review-article/459939.png","ImageObject",300,407,{"name":92,"@type":93},"Dipper","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is risk stratification important in smoldering multiple myeloma (SMM)?","Question",{"text":113,"@type":114},"SMM progression risk varies widely, so individualized risk stratification is needed to guide management decisions.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What limitations did earlier SMM risk models have?",{"text":118,"@type":114},"Earlier models relied on static clinical markers reflecting tumor burden, which did not capture the disease’s underlying biological heterogeneity.",{"name":120,"@type":111,"acceptedAnswer":121},"What new approaches are being used to refine SMM management decisions?",{"text":122,"@type":114},"Recent strategies incorporate dynamic biomarkers, cytogenetics, and genomic profiling, and they recognize immune dysregulation and subclonal evolution as key progression drivers. Clinical trials are also testing early therapeutic interventions for high-risk patients.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},459939,1790811857,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":105,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41,"preview_page_count":4},1374404997633,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","DOI: 10.1002/hem3.70275  \nREVIEW A RTIC L E  \nNavigating the evolving management of smoldering multiple myeloma  \nM. Bakri Hammami1,2  | Rafael R. Canevarolo3 | Ariosto S. Silva3 |  \nMelissa Alsina4 | Nagi Kumar5 | Rachid Baz6 | Kenneth H. Shain6 Correspondence: Kenneth H. Shain ([Ken.Shain@moffitt.org](Ken.Shain@moffitt.org))  \nAbstract  \nSmoldering multiple myeloma (SMM) represents an intermediate clinical stage between monoclonal gammopathy of undetermined significance (MGUS) and symptomatic multiple myeloma (MM) . SMM carries a highly variable risk of progression to MM, requiring individualized risk stratification to guide management. Historically, risk models relied on static clinical markers reflective of tumor burden to predict progression. While useful, these models failed to capture the underlying biological heterogeneity of the disease. Recent advances have incorporated dynamic biomarkers, cytogenetics, and genomic profiling, providing a more nuanced understanding of disease trajectory. Immune dysregulation and subclonal evolution are now recognized as key drivers of progression, enabling the development of biologically informed risk models. Clinical trials have begun to challenge the traditional watch‐and‐wait approach by exploring early therapeutic interventions for high‐risk SMM patients. However, uncertainty persists as clinicians balance the risks of overtreatment against therapeutic delay in the absence of clearly defined high‐risk criteria. This review charts the evolution of SMM from a clinically defined entity to a biologically characterized precursor state, highlighting emerging tools and strategies aimed at improving risk prediction and patient outcomes. As personalized medicine continues to advance, integrating evolving molecular, immunologic, and clinical data will be pivotal in refining the management of SMM.  \nINTRODUCTION  \nMultiple myeloma (MM) is a hematologic malignancy characterized by the uncontrolled expansion of clonal plasma cells (PCs) .1 Since its first description in the 1840s,2 the definition and treatment of MM underwent numerous revisions, allowing earlier and more accurate recognition of affected patients. A key milestone was the recognition of monoclonal gammopathy of undetermined significance (MGUS) in the 1970s as a precursor state of MM.3 However, later observations showed that some patients fulfilled the diagnostic criteria for MM yet had no signs or symptoms of MM, clinically resembling an MGUS state. A case series by Kyle and Greipp (1980) followed six such patients for over 5 years and demonstrated that, for this subgroup, the risks of treatment might outweigh the potential benefits.4 This led to the establishment of smoldering multiple myeloma (SMM), a disease state that is clinically similar to MGUS but biologically resembles MM. However, this classification was primarily based on  \n1Department of Hematology and Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA  \n2Department of Hematology and Oncology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA  \n3Department of Metabolism and Physiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA  \ndisease burden cutoffs reported in retrospective single‐center studies.4,5 This continuous spectrum of monoclonal gammopathies forms the basis of our current understanding of myelomatous disease spectrum, which includes MGUS, SMM, and newly diagnosed MM.  \nThe clinical challenge of SMM lies in its highly variable and heterogeneous natural history. Many patients remain in the smoldering phase for years, while others progress rapidly to MM.6 Significant strides have been made to characterize and stratify the risk of progression from SMM to MM. This distinction has become even more critical with the advent of novel therapeutic agents. Current treatment strategies are generally divided into two approaches: prevention of progression through single‐agent or doublet therapie","cbCaicJqZwBhx366","https://ap.wps.com/l/cbCaicJqZwBhx366","pdf",1077820,"English","# Abstract\n# Introduction\n# Early Definition of SMM","[{\"question\":\"Why is risk stratification important in smoldering multiple myeloma (SMM)?\",\"answer\":\"SMM progression risk varies widely, so individualized risk stratification is needed to guide management decisions.\"},{\"question\":\"What limitations did earlier SMM risk models have?\",\"answer\":\"Earlier models relied on static clinical markers reflecting tumor burden, which did not capture the disease’s underlying biological heterogeneity.\"},{\"question\":\"What new approaches are being used to refine SMM management decisions?\",\"answer\":\"Recent strategies incorporate dynamic biomarkers, cytogenetics, and genomic profiling, and they recognize immune dysregulation and subclonal evolution as key progression drivers. Clinical trials are also testing early therapeutic interventions for high-risk patients.\"}]","Navigating the evolving management of smoldering multiple myeloma - Review Article | PDF",1790757302]