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Editor’s note: Patients with asymptomatic multiple myeloma lack evidence of end-organ damage and do not receive systemic treatment. Patients do progress to symptomatic myeloma requiring treatment, but there is great inter-individual variability. Clinical risk factors for progression such as M protein type and concentration, and percentage of plasma cells in the bone marrow, do exist; however, better predictive accuracy for progression would be useful clinically. Increased numbers of focal lesions detectable by magnetic resonance imaging (MRI) of the axial skeleton confers a worse prognosis in patients with symptomatic multiple myeloma. This study aimed to investigate whether an increased number of focal lesions on MRI had prognostic significance in patients with asymptomatic multiple myeloma.