Diagnosed with SMM, SPB, or MGUS?

Learn how you can stall the development of full-blown Multiple Myeloma with evidence-based nutritional and supplementation therapies.

Click the orange button to the right to learn more.

Smoldering Multiple Myeloma?

Share Button

Smoldering multiple myeloma with an increasingly abnormal serum free light chain (FLC) ratio is associated with a higher risk for progression to active multiple myeloma

Hi David- I was diagnosed with with monoclonal gammopathy of undetermined significance (MGUS) in 2009. I progressed to smoldering multiple myeloma (SMM) this year based on-

  • My bone marrow biopsy, 10-20% plasma cells.
  • My Freelight chain- kappa/lambda ratio increased,
  • but no CRAB symptoms.

I am seeing hematologist/oncologist at university of new mexico comprehensive cancer center. She is watching and waiting for any changes. My questions are:

  • Should I get a second opinion and if so from which facility?
  • Does smoldering multiple myeloma always progress?

Hi Andrew-
While progressing from MGUS to SMM can be difficult in my experience, you are doing well. Managing an MGUS diagnosis from 2009 to 2022 is not easy. If you ever do progress to full MM, you will be early stage aka MM stage 1.
I point this out because, according to research 95% of all newly diagnosed MM patients are relatively advanced at stage 2 or 3. In my experience the early stage 1 MM patient can be overwhelmed by the standard-of-care induction therapy of RVd for 4-6 cycles.
Working with a hem/onc. since 2009 is fine but, in my experience, you will be better off for the long-term if you establish a working relationship with a MM specialist. I am not saying that you need a second opinion. With no CRAB symptoms and with a 10-20% plasma cell percentage in your bone marrow there is little that a conventional oncologist can do for you at this point.
I say “little you can do” because conventional oncology defines MM in a specific way and does not consider your diagnosis to be full MM. Conventional treatments before a full MM diagnosis have never been shown to increase overall survival aka length of life.
A key indicator of your risk to a full MM diagnosis is your K/L ratio. Do you mind if I ask what it is? Are you experiencing any symptoms at all?
In fact, the best way to address your second question “does smoldering myeloma always progress” is to determine your risk as well a live an anti-MM lifestyle through evidence-based, non-conventional therapies such as 
  • Anti-angiogenic nutrition
  • Anti-angiogenic, anti-inflammatory supplementation
  • Anti-MM lifestyle therapies such as whole body hyperthermia 
I will link the Pre-MM Cancer Coaching guides below for the introduction as well as nutrition guide.
Let me know if you have any other questions Ann. Hang in there,
David Emerson
  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Smoldering multiple myeloma

Smouldering myeloma is a disease classified as intermediate in a spectrum of step-wise progressive diseases termed plasma cell dyscrasias. In this spectrum of diseases, a clone of plasma cells secreting monoclonal paraprotein (also termed myeloma protein or M protein) causes the relatively benign disease of monoclonal gammopathy of undetermined significance.

This clone proliferates and may slowly evolve into more aggressive sub-clones that cause smouldering multiple myeloma.

Further and more rapid evolution causes the overtly malignant stage of multiple myeloma and can subsequently lead to the extremely malignant stage of secondary plasma cell leukemia.[1][2][3] Thus, some patients with smouldering myeloma progress to multiple myeloma and plasma cell leukemia.

Smouldering myeloma, however, is not a malignant disease. It is characterised as a pre-malignant disease that lacks symptoms but is associated with bone marrow biopsy showing the presence of an abnormal number of clonal myeloma cells, blood and/or urine containing a myeloma protein, and a significant risk of developing into a malignant disease.[2]…


Smoldering multiple myeloma is characterised by:[4]

  • Serum paraprotein >30 g/l or urinary monoclonal protein ≥500 mg per 24 h AND/OR
  • Clonal plasma cells >10% and <60% on bone marrow biopsy AND
  • No evidence of end organ damage that can be attributed to plasma cell disorder AND
  • No myeloma-defining event (>60% plasma cells in bone marrow OR Involved/Uninvolved light chain ratio>100)


Treatment for multiple myeloma is focused on therapies that decrease the clonal plasma cell population and consequently decrease the signs and symptoms of disease. If the disease is completely asymptomatic (i.e. there is a paraprotein and an abnormal bone marrow population but no end-organ damage), as in smouldering myeloma, treatment is typically deferred, or restricted to clinical trials.[5]

They are generally responsive to IL-1β neutralisation.[6]


Smouldering myeloma with an increasingly abnormal serum free light chain (FLC) ratio is associated with a higher risk for progression to active multiple myeloma.[7]

Multiple Myeloma: Statistics

“The overall 5-year survival rate for people with multiple myeloma in the United States is 55%.

For the 4% of people who are diagnosed at an early stage, the 5-year survival rate is over 77%. If the cancer has spread to a distant part of the body, the 5-year survival rate is over 54%. Approximately 96% of cases are diagnosed at this stage…”


Leave a Comment: