Join Professor Brea Lipe and Professor Sagar Lonial as they discuss the changing treatment landscape of smoldering multiple myeloma (SMM). With a recently approved treatment for high-risk SMM, knowing how to differentiate and manage SMM compared with monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) has never been more crucial. Professors Lipe and Lonial review the case of a 58-year-old man in good health with no anemia or other health concerns, whose annual checkup reveals an isolated finding of elevated total protein. As they follow this patient’s journey, they discuss best practice in diagnosis, risk stratification, and management of SMM. Finally, they consider the factors affecting decision-making in the context of data from early intervention trials that aimed to either delay progression to active MM or, potentially, to cure SMM. Learning Objectives:Explain the distinction between MGUS, SMM and MM Describe the key tests required for a basic workup of a case of suspected clonal plasma cell disorder Explain how patients with SMM may be risk-stratified Evaluate the factors that influence the decision to treat or monitor a case of high-risk SMM Discuss published clinical trial data on high-risk SMM management approaches

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