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Smoldering Multiple Myeloma (SMM). Questions and Answers
I wanted to start a discussion specifically on SMM. Asking specific questions about time of diagnosis, like age, m-spike level, protein in urine level and % of bone marrow involvement. If you had MGUS prior to diagnosis? Any bone or joint paint? What your Hem-onc has as your monitoring schedule? Etc.
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I go to Siteman in St Louis, MO
I have low risk SMM.
I've been smoldering for
1 1/2 years.
I've seen on another site that Tecvayli has been used for intermediate & high risk
@rknicker, how did the bone marrow biopsy go? Did you review the results yet with your hematologist?
@sallik74
Check with your team. I research above on Chat GPat but always verify with your hematologist/oncologist.
What Tecvayli is
• A bispecific antibody (BCMA × CD3) that redirects your own T-cells to attack myeloma cells
• Given as a subcutaneous injection
• Designed for more advanced disease settings
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📊 Where Tecvayli is approved (as of 2026)
• Initially (2022): for heavily pretreated relapsed/refractory multiple myeloma (after ≥4 prior therapies) 
• Updated (March 2026): now also approved earlier (after ≥1 prior line) in combination with daratumumab 
👉 Key point:
All approvals are for active multiple myeloma that has already been treated, not early or smoldering disease.
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🚫 Why it’s NOT used in smoldering myeloma
Smoldering myeloma is treated very differently:
• Goal = delay progression, not aggressive immune activation
• Many patients are observed or treated with lower-intensity approaches
• Tecvayli:
• Has significant immune effects (cytokine release syndrome, infection risk)
• Is considered too intensive for early disease at this time
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🔬 Is it being studied earlier? (This is where it gets interesting)
Yes—this is likely why it’s on your radar.
There are ongoing clinical trials looking at:
• Tecvayli in earlier lines of myeloma
• Combinations like Tecvayli + daratumumab (already moving earlier)
• Potential future use in high-risk smoldering myeloma
But:
👉 No standard-of-care use yet for SMM
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2 Reactions@donna195 I have high-risk IgA kappa free light chain SMM with the 1q21 gain and HLA-DQ8 irksome genetics. I don't have CRAB symptoms, but will likely start I-VRD treatment this year due to the high risk. We all have different risk factors and treatment options/modifications. I've had MGUS for 10 years and it ramped up quickly to SMM in the last year. PET scan did not show MM.
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5 Reactions@donna195
Thank you so much !
@sallik74 your very welcome. I have learned to research, read and ask questions at every appointment. Don’t be afraid to ask your doctor. They are our lifelines! Good luck. I just started treatment on Darzalex 3 weeks ago For High risk SMM and the same day found out I had progressed to Mm and they changed treatment plan the next week to DVRd for 8 weeks then retest. It is a pricess. Stay positive and keep moving.
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4 Reactions@donna195
Does your insurance pay for your meds ?
Any side effects from the darzalex?
I'm already getting anxious for my 3 month blood test.
Hope there are none or minimal side effects on your Dvrd. 8 weeks too sounds short term. Go beat that beast down !!!
@colleenyoung Just got back part of it today. Mayo appt tomorrow. Thank you for asking.
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1 Reaction40% in bone marrow, 333 k/l ratio, but no CRAB symptoms so still smoldering, no treatment at this time.
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1 Reaction@sallik74
Diagnosed with high risk SMM in August 2025. Have just started Darzalex FasPro (had three infusions so far). So far all well, no side effects or otherwise. Have you discussed this treatment with your oncologist?