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Smouldering Myeloma
Related Subjects: |Hypercalcaemia |Multiple Myeloma |Extramedullary Plasmacytoma |Smoldering Myeloma |MGUS |Waldenstrom's Macroglobulinaemia |Oncological emergencies
🩸 About
- Smouldering myeloma is an asymptomatic, early form of myeloma that may remain stable for years but carries a high risk of progression to active multiple myeloma.
❌ Features that Must be Absent (No CRAB/SLiM criteria)
- ⚠️ Hypercalcaemia: Serum calcium >2.75 mmol/L
- ⚠️ Renal impairment: Creatinine >177 µmol/L or clearance <40 ml/min
- ⚠️ Anaemia: Haemoglobin <100 g/L
- ⚠️ Bone lesions: ≥1 lesion on X-ray, CT, or PET/CT
- ⚠️ ≥60% clonal plasma cells in bone marrow
- ⚠️ Serum free light chain ratio ≥100
- ⚠️ ≥2 bone lesions ≥5 mm each on MRI
🧑⚕️ Clinical Features
- Usually asymptomatic – detected incidentally on blood tests for another reason.
🔬 Investigations
- 📊 Bloods: FBC, U&E, calcium typically normal.
- 💉 Paraprotein: ≥30 g/L in serum and/or ≥500 mg/24h in urine.
- 🦴 Bone marrow biopsy: 10–60% plasma cells.
- 🖼️ Imaging: No lytic bone lesions.
💊 Management
- 👀 Standard approach is “watch and wait” with regular monitoring (bloods & imaging).
- 🔥 High-risk smouldering myeloma (e.g. rising paraprotein, abnormal FLC ratio) → may benefit from early treatment with novel agents (clinical trial setting).
📊 Smouldering vs Active Myeloma
| Feature | 🟡 Smouldering Myeloma | 🔴 Active Myeloma |
|---|---|---|
| Symptoms | ❌ None (asymptomatic) | ✅ Symptomatic (bone pain, fatigue, infections) |
| Paraprotein | ≥30 g/L serum and/or ≥500 mg/24h urine | Any level + evidence of end-organ damage |
| Bone Marrow Plasma Cells | 10–60% | ≥10% plus CRAB/SLiM features |
| CRAB Criteria | ❌ Absent | ✅ Present:
🟠 HyperCalcaemia 🟠 Renal impairment 🟠 Anaemia 🟠 Bone lesions |
| SLiM Biomarkers | ❌ Absent | ✅ Present:
📈 ≥60% plasma cells 📈 FLC ratio ≥100 📈 ≥2 MRI focal lesions ≥5 mm |
| Management | 👀 Watch & Wait
Regular monitoring |
💊 Active treatment
(e.g. chemotherapy, immunotherapy, stem cell transplant) |
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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