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The plasma-cell dyscrasias encompass a spectrum of disorders, including monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma, plasmacytoma, amyloidosis, and plasma-cell leukemia. An asymptomatic form, smoldering myeloma (SM), is defined by the presence of monoclonal paraprotein (an M-spike of >3 g/dL), bone-marrow plasmacytosis greater than 10%, or both, and absence of symptoms, anemia, lytic bone lesions, hypercalcemia, or renal insufficiency. Although most SM patients progress to overt myeloma or amyloidosis, the time course and risk factors for progression have not been well defined.
A Mayo Clinic group retrospectively reviewed medical records of 276 patients who were diagnosed with SM from 1970 through 1995; this c…