Smouldering myeloma
Smouldering myeloma is the name given to myeloma that has no symptoms or signs of damage to your organs.
What you need to know:
- Smouldering myeloma is an inactive form of myeloma that doesn’t cause any symptoms or harm.
- People with smouldering myeloma usually have no treatment unless the myeloma becomes active.
- Smouldering myeloma is usually monitored with regular tests to spot any changes.
- Active monitoring is a safe way of monitoring smouldering myeloma.
What is smouldering myeloma?
In smouldering myeloma, there are fewer abnormal plasma cells in the bone marrow than in active myeloma. There are also fewer paraproteins and light chains in the blood. But the levels are higher than in MGUS.
Smouldering myeloma is sometimes called asymptomatic myeloma, because it does not cause symptoms.
If you have smouldering myeloma, you won’t usually need treatment straight away. You will have regular check-ups so your hospital team can tell if the myeloma is changing and becoming active.
This approach is called active monitoring. Some medical staff call it watchful waiting, watch and wait, or expectant management.
Why wait for treatment?
It’s usually better to delay treatment if you have no symptoms or signs of damage to your bones or other organs.
If your doctor recommends active monitoring, it’s because it’s best for you and the type of myeloma you have. This will be a clinical decision based on scientific evidence, not the cost of treatment.
There are some situations where doctors may recommend treatment for smouldering myeloma:
- if tests show that it has a very high risk of progressing to active myeloma soon
- if you have no symptoms, but there are signs – or a high risk – of damage to organs such as the bones or kidneys
- as part of a clinical trial.
"I had a long list of questions for my consultant. I started to ask them, but then I said, ‘You’d better have this sheet’. He answered my questions one by one, which was brilliant."
Joan, living with myeloma since 2006
Order our free myeloma booklet including questions to ask your medical team.
The emotional impact of active monitoring
It can be hard to hear that you have cancer but are not going to have any treatment. Many people say they feel anxious, particularly around the time of their check-ups.
It’s completely understandable to feel this way. But it’s important to know – if your doctor has recommended active monitoring, then it is safe not to have treatment at this time.
It may help to read our information about active monitoring. It includes personal stories from people who are on active monitoring themselves.
You may also like to join our online community forum to connect with other people on active monitoring for blood cancer.
If you want to talk to someone, contact our Support Service on 0808 2080 888 or [email protected] and tell us how you are.
You can also ask your GP or hospital team for a referral for counselling or you may be able to refer yourself. We have more information about how to get professional help, including counselling.
Connecting with others
Myeloma isn’t the only condition where active monitoring may be an option. It’s used for other types of blood cancer too, such as chronic lymphocytic leukaemia (CLL) and follicular lymphoma.
Currently there are over 53,000 people on active monitoring for blood cancer in the UK. So there are many other people in a similar situation. It might help to talk to some of them on our online community forum.
Active monitoring FAQs
Why am I not having treatment for myeloma?
Myeloma can be treated, but almost always comes back. You usually won’t need treatment for myeloma if you have no symptoms and no signs of damage in your bones or organs.
There are benefits in waiting to have treatment:
- You can avoid treatment side effects for as long as possible.
- Treatments can become less effective after a while. So, although there are lots of treatments for myeloma, it’s best to delay your first treatment until you need it. This will leave you with more treatment options in the future.
- New treatments for myeloma are constantly being tested and approved. So waiting may give you more or better treatment options when you actually need treatment.
What does active monitoring involve?
You will have regular check-ups with a haematologist (specialist in blood diseases). They will:
- order blood tests
- ask if you have any symptoms
- do a scan, bone marrow biopsy or urine test, if needed.
Find out more about blood cancer tests, including tests used to monitor myeloma.
How often will I need a check-up?
Your doctor will tell you how often you need to be monitored to start with. If your test results stay the same and you don’t develop symptoms, then you may need appointments less often.
What if I notice symptoms between check-ups?
You should contact your hospital team if you notice anything different. It’s important to be aware of the symptoms of myeloma and symptoms of infection. Do report any changes or problems you have, even if you’re not sure they’re relevant.
How long will I be on active monitoring?
You may stay on active monitoring for a few months to several years. It’s difficult to predict when smouldering myeloma might become active, as everyone is different. Your hospital team are the best people to ask about your situation, as they will be monitoring you.
We do know that if smouldering myeloma shows no changes for five years, its risk of becoming active drops a lot, and gets lower over time.
How will I know when I need treatment?
There are a few things doctors will look at when deciding whether it’s time to start treatment:
- the level of paraprotein or light chains in your blood
- signs that the myeloma has started to cause damage – to your bones or kidneys, for example
- whether you have any symptoms.
Your hospital team will be happy to explain your test results and what they mean, so don’t be afraid to ask.
You may also want to keep a diary of any symptoms, so you remember to tell your hospital team. This may help you feel a little more in control.
What else should I know?
Myeloma, including smouldering myeloma, can increase your risk of infections. This is because the disease affects your immune system.
It’s important to keep up-to-date with recommended vaccines, to help protect against infections. It’s also a good idea to learn about possible signs of infection and what to do if you think you have an infection.
Join our Online Community Forum
Use our supportive Online Community Forum to connect with others affected by blood cancer and share your experiences. You can also explore our 'ask the nurses' threads to hear from our nurses about topics such as active monitoring.
More About ThisAbout this page
This information has been accredited with the PIF TICK, the UK's only quality mark for trusted health information.
Last full review May 2026. Next full review due May 2029. We may make factual updates between reviews.
Thank you to Consultant Haematologist Dr Emma Searle and Clinical Nurse Specialist Amie Martin for checking the clinical accuracy of our myeloma information. Thanks also to Cecelia, Craig, Joan, Kaleigh, Kerry, Louise, Mart, Sandra, Scott for supporting this project and sharing their experience of living with myeloma.