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.
The MAYO 2008 model also incorporates parameters such as bone marrow and plasma cell percentage, M-protein levels, and sFLC ratios.
If the patient does not show any signs of change, additional visits after the initial 5 years will separated by 6 months instead.
High risk patients require early intervention to prevent or delay the progression towards symptomatic multiple myeloma and other complications.
Many clinical trials have shown that a lenalidomide based therapy can significantly lengthen the time before the patient progresses to symptomatic multiple myeloma.
The reason as to not immediately go straight to myeloma like therapy is due to the high amount of regulation required.