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Early intervention for smoldering myeloma raises significant considerations for healthcare professionals, particularly regarding risk stratification and treatment recommendations. Research indicates that approximately 10% of patients diagnosed with monoclonal gammopathy of undetermined significance (MGUS) may develop smoldering myeloma, affecting a substantial population in the UK. It is crucial to categorize smoldering myeloma into low, standard, and high-risk groups, as higher-risk patients demonstrate a 60-80% chance of progressing to active myeloma within two years. While researchers are exploring intervention strategies, the necessity for clinical trials showcasing overall survival advantages and acceptable toxicity profiles remains paramount before changing current practice norms.