Natural History Study of Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Myeloma (SMM)

Background: * Multiple Myeloma (MM) is an incurable plasma cell neoplasm with a median survival of 3-4 years. * Monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM) are premalignant plasma cell proliferative disorders characterized by elevated monoclonal protein and bone marrow plasma cells. MGUS affects 3.2% of Caucasians over the age of 50 and has a 1% annual risk of progression to MM. approximately 3000 cases of SMM are diagnosed annually with a 10% annual risk of progression to MM. * Current risk stratification schemes rely on serum protein markers and phenotyping by flow cytometry. While they can differentiate high and low risk patients, they cannot predict outcome for individual patients, are not integrated with one another, and have limited direct correlation to biology. * Paired samples linked to clinical information can advance research into improved risk stratification, the pathogenesis of MGUS, SMM, and MM, and the potential for an early treatment window for these incurable diseases. Objectives: * To characterize the natural history and prognosis of MGUS and SMM * To integrate protein markers (including immunoglobulin free light-chains) and immunophenotyping by flow cytometry with molecular profiles (including gene expression profiles) and clinical outcomes * To apply expertise and diagnostic technology to provide improved evaluation, monitoring, and risk-stratification for patients on this protocol * To provide paired samples of blood and tissue linked to clinical and molecular information for pilot translational studies Eligibility: * A confirmed diagnosis of MGUS or SMM (based on IMWG diagnostic criteria) * Age greater than or equal to 18 years * ECOG performance status in the range of 0-2 * Patients who have a diagnosis of MM are not eligible for this study. Design: * This is a prospective cohort study of patients with either MGUS or SMM. * Following initial evaluation and confirmation of diagnosis, patients will be followed as clinically indicated, usually at 12 month intervals. * The primary endpoint is progression to MM requiring treatment. * Patients may donate cellular products or tissues as appropriate for research purposes. 154 patients with MGUS and 154 patients with SMM will be enrolled on this protocol.