Heinz Ludwig, MD, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria, discusses the results and implications of a retrospective study assessing the risk of progression to multiple myeloma in patients with smoldering multiple myeloma with a serum free light chain (FLC) ratio ≥100. The study found that while this threshold is associated with a high risk of progression, with a median time to progression of 31 months, only a minority of patients progressed in the first six months and less than 50% progressed within a year, and select patients never progressed to multiple myeloma. These results suggest that treatment should not be initiated in all patients with a FLC ratio ≥100, and other high-risk features should be considered when making the decision to start therapy. This interview took place at the European Hematology Association (EHA) Congress 2022 held in Vienna, Austria.

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