Haematology Oncology

20/2/20 Risk Score for Smouldering Myeloma

Predicts 2-year progression risk from smouldering (asymptomatic) myeloma to symptomatic multiple myeloma using the 20/2/20 model.

Score interpretation

Low Risk — Watch and Wait 0

No risk factors: about 6% progress to multiple myeloma within 2 years (IMWG 2020); median time to progression 110 months (Mayo 2018).

→ Watch and wait. Monitor every 6 months (blood counts, protein electrophoresis, renal function).

Intermediate Risk 1

One risk factor: about 18% progress within 2 years; median time to progression 68 months.

→ Closer monitoring (every 3–4 months). Consider clinical trial enrolment. Bone survey/PET-CT.

High Risk — Consider Early Treatment 2–3

Two or three risk factors: about 44% progress within 2 years; median time to progression 29 months.

→ High risk. Discuss early treatment (daratumumab-based) or clinical trial. Monitor every 3 months. Bone MRI.

Interpretation bands for the Smouldering Myeloma 20/2/20. Apply clinical judgement and local guidance.

Lakshman A, Rajkumar SV, Buadi FK, et al. Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria. Blood Cancer J. 2018;8(6):59.
Mateos MV, Kumar S, Dimopoulos MA, et al. International Myeloma Working Group risk stratification model for smoldering multiple myeloma (SMM). Blood Cancer J. 2020;10(10):102.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.