IMWG consensus on risk stratification in multiple myeloma

Multiple myeloma (MM) is a heterogeneous disease with variable response to treatment and outcome. ​ The International Myeloma Working Group (IMWG) has proposed a consensus on risk stratification in MM to better understand and apply treatment. ​ Prognostic markers have been identified and categorized into host factors, tumor characteristics, tumor burden/stage, and tumor responsiveness to treatment. ​ Age is an important host factor, with incremental shortening of survival in increasing age bands. ​ Tumor-related factors include genetic aberrations such as t(4;14) and 17p13 deletion, which are associated with poor survival. ​ The International Staging System (ISS) combines host factors (serum albumin and beta-2 microglobulin) to determine tumor burden/stage. ​ A combined genetics-ISS model has been developed to further stratify patients into risk groups. ​ Depth of response to treatment, particularly achieving complete remission (CR), is associated with improved overall survival. ​ However, sustaining CR and achieving very good partial response or immunophenotypic remission may also impact survival. ​ High-risk patients with identifiable genetic abnormalities have comparable response rates but are more likely to experience early relapse. ​ Risk stratification in MM is important for tailoring treatment and improving outcomes. ​ Further research is needed to refine prognostic markers and determine the optimal treatment strategies. ​

List of important points:

1. Multiple myeloma (MM) is a heterogeneous disease with variable response to treatment and outcome. ​
2. The International Myeloma Working Group (IMWG) has proposed a consensus on risk stratification in MM. ​
3. Prognostic markers have been identified and categorized into host factors, tumor characteristics, tumor burden/stage, and tumor responsiveness to treatment. ​
4. Age is an important host factor, with incremental shortening of survival in increasing age bands. ​
5. Tumor-related factors include genetic aberrations such as t(4;14) and 17p13 deletion, which are associated with poor survival. ​
6. The International Staging System (ISS) combines host factors (serum albumin and beta-2 microglobulin) to determine tumor burden/stage. ​
7. A combined genetics-ISS model has been developed to further stratify patients into risk groups. ​
8. Depth of response to treatment, particularly achieving complete remission (CR), is associated with improved overall survival. ​
9. Sustaining CR and achieving very good partial response or immunophenotypic remission may also impact survival. ​
10. High-risk patients with identifiable genetic abnormalities have comparable response rates but are more likely to experience early relapse. ​
11. Risk stratification in MM is important for tailoring treatment and improving outcomes. ​
12. Further research is needed to refine prognostic markers and determine the optimal treatment strategies. ​

Authors:

WJ Chng, A Dispenzieri, C-S Chim, R Fonseca, H Goldschmidt, S Lentzsch, N Munshi, A Palumbo, JS Miguel, P Sonneveld, M Cavo, S Usmani, Brian G.M. Durie, and H Avet-Loiseau on behalf of the International Myeloma Working Group

Citation:

Leukemia. 2014;28(2):269-277.
doi:10.1038/leu.2013.247