Smoldering multiple myeloma (SMM) is an asymptomatic condition that occupies a space between monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) along the spectrum of clonal plasma cell proliferative disorders. It is not a biologic intermediate stage between MGUS and MM, but rather represents a heterogeneous clinically defined condition in which some patients (approximately two-thirds) have MGUS (pre-malignancy), and some (approximately one-third) have MM (biologic malignancy). Unfortunately, no single pathologic or molecular feature can reliably distinguish these two groups of patients. For purposes of practice and clinical trials, specific risk factors are used to identify patients with SMM in whom malignant transformation has already likely occurred (high risk SMM). Patients with newly diagnosed high risk SMM should be offered therapy with lenalidomide or lenalidomide plus dexamethasone (Rd) for 2 years, or enrollment in clinical trials. Patients with low risk SMM should be observed without therapy every 3–4 months.
冒烟型多发性骨髓瘤（SMM）是一种无症状的疾病，在克隆性浆细胞增殖性疾病的谱系中介于意义未明的单克隆丙种球蛋白病（MGUS）与多发性骨髓瘤（MM）之间。它并非MGUS与MM之间的生物学中间阶段，而是一种异质性的临床定义状态，其中部分患者（约三分之二）实际患有MGUS（癌前病变），另一部分患者（约三分之一）已患有MM（生物学意义上的恶性肿瘤）。遗憾的是，目前尚无单一的病理或分子特征能可靠区分这两类患者。在临床实践和试验中，通常采用特定的危险因素来识别可能已发生恶性转化的SMM患者（高危SMM）。新确诊的高危SMM患者应接受为期2年的来那度胺或来那度胺联合地塞米松（Rd）治疗，或参与临床试验。低危SMM患者则应每3-4个月进行随访观察，无需治疗。
肿瘤(癌症)患者之家