Risk Stratification of Precursors to Multiple Myeloma in 2020.

With advances in the treatment of plasma cell disorders, there have also been improvements in the risk stratification of these diseases. There are currently no screening recommendations for monoclonal gammopathy of unknown significance (MGUS); however, new studies are analyzing the role of screening for patients age 40-75 who are African American or have a family history of multiple myeloma (MM). Patients with smoldering multiple myeloma (SMM) have an increased risk of progression to MM when compared to MGUS. Data have shown that evaluation of bone marrow biopsy, full body MRI and free light chain ratios can identify high-risk SMM patients. Current investigation into early initiation of treatment for patients with SMM who do not meet criteria for MM showed improvement in time to progression. By continuing to evaluate clinical markers of disease burden, physicians can risk stratify patients to identify those at highest risk for progression to MM.