42 NCCN Guidelines for Patients ® : Multiple Myeloma, 2019 4 Treatment guide Smoldering (asymptomatic) multiple myeloma Smoldering (asymptomatic) multiple myeloma Guide 4. Primary treatment and follow-up for smoldering (asymptomatic) myeloma treatment Cancer type Primary treatment options Follow-up tests Smoldering (asymptomatic) multiple myeloma ª • Observe every 3 to 6 months • Clinical trial ª • CBC with differential and platelet count • Blood chemistry tests: creatinine and corrected calcium • 24-hour urine for total protein, UPEP, and UIFE • Serum quantitative immunoglobulins, SPEP, and SIFE • Serum FLC assay as needed • Bone survey or whole-body low-dose CT scan as needed • Bone marrow aspirate and biopsy with FISH and multi-parameter flow cytometry as needed • Whole-body or skeletal MRI or whole- body FDG PET/CT scan as needed Guide 4 shows the primary treatment options for multiple myeloma that isn’t causing symptoms (smoldering myeloma) and follow-up tests. Myeloma that isn’t causing symptoms is called smoldering (asymptomatic) multiple myeloma. Primary treatment is the initial treatment given to try to rid the body of cancer. Smoldering myeloma often takes months or years to progress to active (symptomatic) myeloma. For this reason, treatment isn’t needed right away. Observation is an option for some patients. Joining a clinical trial is strongly recommended if one is open and is the right fit for you. Observation means that your doctor will watch for cancer growth with regular follow-up tests. Many of the tests used for follow-up are the same as those used to confirm myeloma and assess symptoms. During observation, you should have follow-up tests every 3 to 6 months to check the status of the cancer. (See Part 2 on page 14 for more details about each test.) Next steps If the cancer grows and starts causing symptoms, see Guide 5 on page 43 for treatment options for active (symptomatic) myeloma.