High-Risk Smoldering Myeloma: Single-Agent Therapy or Curative Intent?

The management of high-risk smoldering multiple myeloma (SMM) is undergoing a paradigm shift from observation to early therapeutic intervention. This session will examine the evolving evidence supporting treatment initiation in high-risk SMM, highlighting the emergence of single-agent daratumumab as a lower-toxicity strategy to delay progression and preserve quality of life. In parallel, the rationale and clinical data supporting curative-intent approaches using intensive quadruplet regimens, MRD-driven treatment strategies, and novel immune-based therapies will be reviewed. Recent findings from pivotal clinical trials and major hematology meetings will be discussed, including advances in CAR-T cell and bispecific antibody therapy. Attendees will gain practical insights into patient selection, risk-adapted treatment decisions, and the ongoing debate between disease control and potential cure.