Risk Stratification in Smoldering Multiple Myeloma

In this opening segment, Dr. Sagar Lonial welcomes the audience and frames the discussion around the evolving management of smoldering multiple myeloma, before asking the panel how they currently approach risk stratification in clinical practice. Dr. Vincent Rajkumar explains that the first step is ensuring that patients truly meet criteria for smoldering multiple myeloma by carefully excluding myeloma-defining events, including CRAB features and SLiM biomarkers. Once active disease is ruled out, clinicians can apply validated risk models, such as the IMWG 20/2/20 framework, to estimate the likelihood of disease progression. Dr. Saad Usmani adds that while these models provide a useful starting point, clinicians should also consider how disease markers change over time. He emphasizes that evaluating trends in laboratory parameters and clinical features can offer a more dynamic understanding of progression risk. Together, the panel highlights that effective risk stratification in smoldering multiple myeloma combines established models with careful longitudinal monitoring.