Figure 2
Figure 2. Proposed guidelines of follow-up and management of SMM. Patients suspected to have MM should first be defined as having MGUS, SMM, or myeloma requiring therapy. This includes the new classification of patients with MDE. For patients with SMM, these should then be stratified based on the Mayo Clinic criteria or PETHEMA criteria as having low-risk, intermediate-risk, or high-risk SMM. For high-risk SMM, we would highly recommend clinical trials or very close observation if not enrolled in a trial. We would consider redefining these patients in the future as early myeloma. For low-risk SMM, we would recommend less frequent monitoring if clinically stable and consider redefining these patients as MGUS-like. CRAB is defined as hypercalcemia (serum calcium ≥11.5 mg/dL), renal failure (defined by creatinine ≥1.95 with no other etiology), anemia (hemoglobin ≤10 g/dL or >2 g/dL below the lower limit of normal), or skeletal lesions (lytic lesions by skeletal survey, osteoporosis with pathologic fractures, or cord compression).

Proposed guidelines of follow-up and management of SMM. Patients suspected to have MM should first be defined as having MGUS, SMM, or myeloma requiring therapy. This includes the new classification of patients with MDE. For patients with SMM, these should then be stratified based on the Mayo Clinic criteria or PETHEMA criteria as having low-risk, intermediate-risk, or high-risk SMM. For high-risk SMM, we would highly recommend clinical trials or very close observation if not enrolled in a trial. We would consider redefining these patients in the future as early myeloma. For low-risk SMM, we would recommend less frequent monitoring if clinically stable and consider redefining these patients as MGUS-like. CRAB is defined as hypercalcemia (serum calcium ≥11.5 mg/dL), renal failure (defined by creatinine ≥1.95 with no other etiology), anemia (hemoglobin ≤10 g/dL or >2 g/dL below the lower limit of normal), or skeletal lesions (lytic lesions by skeletal survey, osteoporosis with pathologic fractures, or cord compression).

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