Denosumab for High Risk SMM and SLiM CRAB Positive, Early Myeloma Patients

Inclusion Criteria: * Age ≥ 18 years * Able to provide written informed consent in accordance with federal, local, and institutional guidelines * Must meet criteria of high-risk smoldering MM or early "SLiM CRAB" MM based on the criteria described below: * High-risk SMM is defined here according to the revised Mayo Clinical criteria (2 out of 3 criteria must be fulfilled): * Bone marrow clonal plasma cells \> 20% * Serum M protein \> 2.0g/dL * Serum-free light chain ratio \> 20, measured with "Binding site Kit" * Early 'SLiM CRAB' multiple myeloma * Patients must present with only one of the following features * Bone marrow clonal plasma cells ≥ 60%, or * Serum FLC ratio ≥ 100 (kappa-LC leading) or ≤ 0.01 (lambda-LC leading), measured with "Binding site Kit", or * \>1 Focal bone lesion of ≥5mm (not associated with osteolysis, detected by PET-CT or whole-body low-dose CT (WBLDCT)) * Time from diagnosis of high-risk SMM or SLIM CRAB positive, early MM to study enrollment: \<5 years Exclusion Criteria: * ECOG \>3 * Active, symptomatic MM (fulfilling CRAB-criteria) * Non-secretory MM, extramedullary plasmacytoma, plasma cell leukemia, POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes) * MGUS * Hypocalcemia (can be corrected by drug intervention before start of treatment) * Second malignancy within the past 5 years except: * Adequately treated basal cell or squamous cell skin cancer * Carci…