Which patients with smoldering myeloma do you treat?

Let me address the last comment regarding treatment of high risk smoldering myeloma. IF one thinks that the patient requires treatment for myeloma, why treat with a regimen that is NOT the preferred treatment for myeloma? For example, lenalidomide alone or lenalidomide/dexamethasone. If this were "active" myeloma, one would not treat with a single agent or a doublet. IF one opines that high risk smoldering myeloma patients should be treated, then I would strongly suggest that they be treated as ...

We now have a good understanding of disease heterogeneity in smoldering multiple myeloma. As demonstrated by the Mayo Clinic in 2018 with the "20/2/20" revised risk stratification (bone marrow plasma cells > 20%, M-protein > 2g/dL, and serum free light chain ratio > 20), patients with low risk disease (none of the three risk factors), have a median time to progression of 110 months, whereas patients with intermediate risk (one risk factor) have a median TTP of 68 months, and those with high risk...