Clinical Decision-Making in High-Risk Smoldering Multiple Myeloma

In this segment, Dr. Sagar Lonial asks Dr. Vincent Rajkumar how clinicians decide between continued observation and early intervention once a patient is classified as having high-risk smoldering multiple myeloma. Dr. Rajkumar explains that although risk models can identify patients with a higher probability of progression, treatment decisions still require careful clinical judgment. Factors such as the pace of biomarker changes, the magnitude of M protein increase, and evolving laboratory trends may signal a greater likelihood of progression and influence management strategies. He also highlights the importance of patient-specific considerations, including age, comorbidities, and patient preferences when discussing potential early treatment. Dr. Saad Usmani adds that clinicians often assess whether the disease appears biologically stable or shows signs of progression over time. The panel emphasizes that even among patients categorized as high risk, individualized evaluation remains essential when determining whether observation or early therapeutic intervention is most appropriate in smoldering multiple myeloma.