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Asymptomatic (Smoldering) Myeloma Prognosis

Mayo model risk of progression to active myeloma or amyloidosis.

Asymptomatic (Smoldering) Myeloma Prognosis
Serum M-protein ≥3 g/dL
Bone marrow plasma cells ≥10%
Serum free light chain ratio <0.125 or >8
Result0 risk factors

Low risk of progression to symptomatic myeloma or amyloidosis; median time to progression ~10 years.

Risk category
Low
Median time to progression
~10 years

When to use

  • Stratifying progression risk at diagnosis of smoldering (asymptomatic) multiple myeloma.

Formula

Count of 3 factors: serum M-protein ≥3 g/dL, bone marrow plasma cells ≥10%, serum FLC ratio <0.125 or >8. 1 factor = low risk, 2 = intermediate risk, 3 = high risk.

Pearls and pitfalls

  • Derived from a Mayo Clinic cohort of 273 patients with smoldering myeloma followed for progression.
  • Later refined by the Mayo 2018 “20/2/20” model and the 2020 IMWG model, which are validated in different cohorts.

References

  1. Dispenzieri A, et al. Blood. 2008;111(2):785-9.