DARA RVD For High Risk SMM

Inclusion Criteria: * Age ≥ 18 years. * Must meet criteria of high-risk smoldering MM as described with one of the below criteria: * Bone marrow clonal plasma cells ≥10% and any one or more of the following: * Serum M protein ≥3.0 gm/dL * Immunoparesis with reduction of two uninvolved immunoglobulin isotypes * Serum involved/uninvolved free light chain ratio ≥8 (but less than 100) * Free Light Chain Smoldering Myeloma patients are not excluded * Progressive increase in M protein level (Evolving type of SMM)\*\*\* Increase in serum monoclonal protein by ≥10% on two successive evaluations within a 6-month period * Bone marrow clonal plasma cells 50-60% * Abnormal plasma cell immunophenotype (≥95% of bone marrow plasma cells are clonal) and reduction of one or more uninvolved immunoglobulin isotypes * High Risk FISH defined as any one or several of the following: t(4;14), t(14;16), t(14;20), del 17p or 1q gain * MRI with diffuse abnormalities or 1 focal lesion (≥5mm) * PET-CT with one focal lesion (≥5mm) with increased uptake without underlying osteolytic bone destruction * OR High-risk per IMWG/Mayo 2018 "20-2-20" Criteria (at least 2 of the following) * Bone marrow plasmacytosis ≥20% * ≥ 2g/dl M protein * 20 involved: uninvolved serum free light chain ratio * No evidence of CRAB criteria\* or new criteria of active MM which including the following: * Increased calcium levels: Corrected serum calcium \>0.25 mmol/…