Smoldering Multiple Myeloma : Taking the narrow over the wide path?

Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cells condition considered as a pre-malignant entity that may evolve overtime to symptomatic MM. Based on a “poorly defined” risk of progression, some well-intended investigators proposed prospective interventional trials for these individuals. We believe this may be a harmful intervention and favor a close « wait and watch » approach, and rather enroll these patients in dedicated observational biological studies aiming to better identify patients who will evolve to MM, based on their plasma cells biology, including genomics, epigenetics, and the immune microenvironment.