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A simple score using three numbers, marrow plasma cells over 20 percent, M-protein over 2 grams per decilitre and a free light-chain ratio over 20, sorts smouldering myeloma into risk groups and is used to decide who might be treated early.
Retrospective study of 1,996 patients with smouldering myeloma from international centres developing a risk model based on marrow plasma cell percentage, M-protein level and involved to uninvolved free light-chain ratio, with cytogenetics as an optional fourth variable.
Two-year progression risk ranged from about 6 percent with no risk factors to about 44 percent with all three, and the model was validated in an independent cohort.
The 20/2/20 model defines high-risk smouldering myeloma in current guidelines and trial eligibility, including in AQUILA-informed practice.