Authored by Vincent Rajkumar, published on 2026-02-23 21:19:17.0
Treatment algorithm for smoldering myeloma. Incorporates the 2025 Daratumumab FDA approval for high risk smoldering myeloma. Active drugs in multiple myeloma reference.mSMART 4.0 Risk Stratification of active multiple myeloma.
Potential New Myeloma or Smoldering Myeloma
Any Myeloma Defining Events?
• CRAB,
• ≥60% PC,
• FLC ≥100,
• MRI >1 focal
Treat as Myeloma
No Myeloma Defining Events (SMM)
Intermediate or Low Risk SMM
Observation
High Risk SMM (Median TTP ~2 years)
High Risk SMM or Evolving SMM
Daratumumab x 3 years*
*Alternative is Len x 2 years; High risk by IMWG cytogenetics criteria, may consider MM therapy