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. 2021 Apr 7;11(4):70. doi: 10.1038/s41408-021-00460-0

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — A Flow-chart for study inclusion: Among 5116 patients diagnosed with MM or SMM and registered in the DMMR, a diagnostic sFLC result was available in 2515 patients and 785 had a normal sFLC ratio. Of these patients, 139 had an MGUS-like phenotype IgG M-protein ≤1.5 g/dl or an IgA M-protein ≤1.0 g/dl and with normal levels of normal hemoglobin, creatinine, ionized calcium and no amyloidosis, medullary compression syndrome, extramedullary myeloma, peripheral neuropathy or dialysis-dependent renal failure at presentation. MM multiple myeloma, SMM smoldering myeloma, sFLC serum free light chain. B Incidence of multiple myeloma in Denmark: The columns with values displayed on the left vertical axis show the incidence of multiple myeloma pr. 100.000 in Denmark, age adjusted to the EU 2013 standard population. Filled circles present the age-adjusted incidence for all MM patients and the filled triangles present the age-adjusted incidence of myeloma patients with an IgG M-protein ≤1.5 g/dL and IgA M-protein ≤1.0 g/dL and normal blood levels of ionized calcium, creatinine, and hemoglobin. The gray bars with values displayed on the right vertical axis show the percentage of patients assessed with sensitive imaging techniques like CT, MRI, and PET (CT/MR/PET) as part of the diagnostic work-up. The years of diagnosis in the calendar period 2005–2017 are shown on the horizontal axis. Patients diagnosed in 2018 were not fully registered at data cut-off.