Study of MGUS, Smoldering Myeloma, Early MDS and CLL to Assess Molecular Events of Progression and Clinical Outcome

The purpose of this research study is to perform these molecular analyses on tissues
(obtained from biopsies), blood, or other body fluids such as saliva. Importantly, this study
will use tissue specimens that have already been collected as part of a participant's
clinical care. The participant's tissue sample may be used to create a living tissue sample
(called a "cell line") that can be grown in the laboratory. This allows researchers to have
an unlimited supply of cells in the future without asking for more samples.

In this study, analyses will be performed on material only after all necessary clinical tests
have been performed. In general, no additional procedures will be required. However, the
investigators are asking the participant's permission to obtain one additional sample of
blood (a few teaspoons), a gentle swab from the inside of their mouth or a sample of skin to
obtain some cells. These are sources of normal, non-cancer cells which are needed for some
types of analyses.

To fully understand the effects that molecular alterations have on blood cancers, they must
be analyzed in the context of clinical behavior. Therefore, this study also asks the
participant's permission to link the molecular alterations in their cancer or leukemia with
clinical information that has been generated during the course of their clinical care. No
additional clinical tests will be required. The investigator will ask to see the participant
for follow up at regular interval to follow their risk of progression.

Some of participant's specimens as well as some of the material generated during the analysis
of their tissues or blood may be useful for future study. The Investigator's are asking for
the participant's permission to store these specimens and materials in a secure storage
facility for possible later use.

Finally, rapid progress in understanding and treating cancer will occur when some of the
molecular information derived from tissue and blood can be shared with other researchers. In
particular, the National Institutes of Health (NIH) and other organizations have developed
special data (information) repositories that analyze data and collect the results of certain
types of genetic studies. These central banks will store genetic information and samples and
give them to other researchers to do more studies. Therefore, the Investigators are also
asking your permission to share your results with these special banks. The participant's
information will be sent with only a code number attached. The participant's name or other
directly identifiable information will not be given to central banks. There are many
safeguards in place to protect the participant's information and samples while stored in
repositories and used for research. The investigators do not think that there will be further
risks to the participant's privacy and confidentiality by sharing this information with these
banks. However, the investigator's cannot predict how genetic information will be used in the
future.

Inclusion Criteria:

- Patients with Known or Suspected Precursor Hematological Cancer

- Including the following subgroups of diseases:

- Early MDS, including pathologically-confirmed MDS (IPSS Low/Int-1; IPSS-R Very
Low/Low) and idiopathic cytopenias of undetermined significance (ICUS);

- Myeloproliferative neoplasms (MPN);

- Asymptomatic Multiple Myeloma and Waldenstrom Macroglobulinemia such as
monoclonal gammopathy of undermined significance (MGUS) or Smoldering Multiple
Myeloma (SMM or SWM);

- Monoclonal B cell lymphocytosis (MBL);

- Early stage asymptomatic low-grade lymphomas; or

- Other precursor conditions or clonal genetic abnormalities of the blood/bone
marrow that do not meet criteria for symptomatic hematological malignancy, or
patients exposed to prior chemotherapies (e. g., alkylating agents, platinum
derivatives, taxanes, topo-2 inhibitors, anti-metabolites, systemic
radioisotopes).

- Patients must be at least 18 years of age to participate in this research.

- Inclusion of Women and Minorities -- In accordance with NIH guidelines, women and
members of minority groups and their subpopulations will be included in this protocol.

Exclusion Criteria:

- Patients with Known or Suspected Precursor Hematological Cancer are NOT EXCLUDED

- Evidence of symptomatic or active hematological malignancy. Patients enrolled on
clinical trials for precursor diseases are NOT excluded from this study.