When to start treatment

Test results will help your doctor work out when to start treatment.

Category	Test results	Need for treatment
monoclonal gammopathy of undetermined significance (MGUS)	low level of paraprotein in blood or urine (less than 30g/L) low level of myeloma cells in the bone marrow (less than 10% clonal plasma cells) no SLiM–CRAB features	not cancer; needs active monitoring as it may progress to myeloma one out of every 100 people diagnosed with MGUS develops myeloma each year
smouldering myeloma (asymptomatic myeloma)	medium level of paraprotein in blood or urine (greater than 30g/L) and/or myeloma cells in the bone marrow (10–59% clonal plasma cells) no SLiM–CRAB features	usually doesn’t need treatment straightaway may progress to active myeloma, so it needs active monitoring
active myeloma (symptomatic myeloma)	SLiM–CRAB features one of the following: greater than 60% (clonal) plasma cells in the bone marrow; ratio of abnormal to normal light chains is less than 100; abnormal MRI with more than one (greater than 5 mm) focal lesion	active myeloma requires treatment

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This information was last reviewed in September 2020. View who reviewed this content.

Prof John Gibson, Haematologist, Institute of Haematology, Royal Prince Alfred Hospital and The University of Sydney, NSW; Dr Stephanie Anderson, Registrar, Institute of Haematology, Royal Prince Alfred Hospital, NSW; Tanya Carney, Consumer; Jacqui Keogh, NSW State Manager/Senior Myeloma Nurse NSW, Myeloma Australia; Dr Silvia Ling, Haematologist, Liverpool Hospital, NSW; Rachel McCann, Myeloma Support Nurse NSW, Myeloma Australia; John McMath, Consumer; Karen Robinson, 13 11 20 Consultant, Cancer Council NSW.

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