# IMWG 20/2/20 risk stratification model for smouldering multiple myeloma

Source: https://onco.cc/key-papers/paper-mateos-20-2-20-smouldering-bcj-2020/  
OnCo record `paper-mateos-20-2-20-smouldering-bcj-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A simple score using three numbers, marrow plasma cells over 20 percent, M-protein over 2 grams per decilitre and a free light-chain ratio over 20, sorts smouldering myeloma into risk groups and is used to decide who might be treated early.

## Summary

Retrospective study of 1,996 patients with smouldering myeloma from international centres developing a risk model based on marrow plasma cell percentage, M-protein level and involved to uninvolved free light-chain ratio, with cytogenetics as an optional fourth variable.

Two-year progression risk ranged from about 6 percent with no risk factors to about 44 percent with all three, and the model was validated in an independent cohort.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: Blood cancer journal
- Year: 2020
- DOI: 10.1038/s41408-020-00366-3
- Authors: Mateos MV, Kumar S, Dimopoulos MA, et al.
- Findings: Two-year progression risk 6 percent, 18 percent and 44 percent for low, intermediate and high risk.; Adding high-risk cytogenetics improved discrimination.
- What it means: The 20/2/20 model defines high-risk smouldering myeloma in current guidelines and trial eligibility, including in AQUILA-informed practice.
- Caveats: Retrospective and based on values at diagnosis; evolving markers over time also matter.

## Sources

- Blood Cancer J 2020: https://doi.org/10.1038/s41408-020-00366-3
- PubMed: https://pubmed.ncbi.nlm.nih.gov/33067414/

## Connected records

- cancers: [Smouldering multiple myeloma](https://onco.cc/cancers/smouldering-myeloma/)
- journals: [Blood cancer journal](https://onco.cc/journals/blood-cancer-journal/)

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