Monitoring smouldering myeloma

Myeloma with no symptoms is called smouldering or asymptomatic myeloma. You may have active monitoring, which means delaying treatment until it is needed.

What is smouldering myeloma?

Myeloma with no symptoms is called smouldering or asymptomatic myeloma.

If you have smouldering myeloma, you may not need treatment straight away. This is because there is no strong evidence that having treatment at this stage will help. Instead, doctors may suggest active monitoring.

What is active monitoring?

This means treatment is delayed until it is needed.

Your doctor will see you every few months to take blood samples and do some other tests. If tests show the myeloma is progressing or you develop symptoms, your doctor will talk to you about starting treatment.

 Waiting to start treatment means you feel well for longer, as you will not have the side effects from treatment. If you are worried about not having treatment, you might find these tips helpful:

  • Make sure you understand why active monitoring is recommended. If you have any concerns, talk to your doctor.
  • Try to think of the time without treatment as an opportunity to make the most of your quality of life. Use your time to do things you enjoy, and to get as fit and healthy as you can.
  • Try to focus on the present, rather than what might happen in the future.
  • Express your feelings. You can do this by talking to family and friends, joining a support group or online forum, or by keeping a journal.

Although active monitoring can be difficult to adjust to at first, many people find it gets easier as time goes on. We have more information about the emotional effects of cancer.

Some people may be offered treatment for smouldering myeloma, but only as part of a clinical trial.

About our information

  • References

    Below is a sample of the sources used in our myeloma information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    National Institute for Health and Care Excellence (NICE). Myeloma: diagnosis and management. NICE guideline [NG35]. Published: 10 February 2016 Last updated: 25 October 2018. Available from: https://www.nice.org.uk/guidance/ng35/chapter/recommendations Accessed: 19/07/22

    Jonathan Sive et al., on behalf of the British Society of Haematology. British Journal of Haematology. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Published: 21 March 2021 Available from: https://onlinelibrary.wiley.com/doi/10.1111/bjh.17410 Accessed: 19/07/22

    M.A. Dimopoulos et al. Annals of oncology. European Society for Medical Oncology (ESMO). Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Volume 32, ISSUE 3, P309-322, March 01, 2021. Available from: https://www.annalsofoncology.org/article/S0923-7534(20)43169-2/fulltext Accessed: 19/07/22


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We try to make sure our information is as clear as possible. We use plain English, avoid jargon, explain any medical words, use illustrations to explain text, and make sure important points are highlighted clearly.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected. Our aims are for our information to be as clear and relevant as possible for everyone.

You can read more about how we produce our information here.