At the 2014 American Society of Hematology (ASH) Annual Meeting, Dr Ola Landgren (Memorial Sloane Kettering Cancer Center, New York, NY) discusses the final results from the NCI phase II pilot study of carfilzomib, lenalidomide and dexamethasone in 12 patients with high-risk smouldering multiple myeloma. He assesses the risks and benefits of this therapeutic approach in clinical practice.