In 2015, the revised international staging system (R-ISS) from the International  Myeloma Working Group (IMWG) was published, which provides the most up-to-date tool for stratifying multiple myeloma patient risk based on prognosis. On October 2020, the IMWG published the risk stratification model for smoldering multiple myeloma (SMM), which identifies three independent factors predicting progression risk at two years.

The Durie-Salmon Staging System  is another staging system that correlates the amount of myeloma to the damage it has caused, such as bone disease or anemia.

Treatment Response

Careful testing after each cycle of treatment will indicate whether the treatment is working or not. If response is slow and side-effects are manageable, additional therapy should be considered. Thus, accurate response assessment is important. As shown below, there is a correlation between test results and the number of myeloma cells. 

Based on the IMWG response criteria - if the response is less than desired, the practitioner and patient should discuss whether to watch and wait, switch therapies, or continue with a maintenance dose.

In March 2021 , the IMWG published "Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group." This policy provides clinical practice recommendations based on phase 2 and phase 3 trials while integrating real-world practice and drug access in low-, medium- and high-incomes countries.


Related Content

The Advanced Practitioner's Guide to Multiple Myeloma
JADPRO Vol. 7 | Supplement 1 | March 2016
Updates in the Diagnosis and Monitoring of Multiple Myeloma


The International Myeloma Foundation medical and editorial content team

Comprised of oncology-certified nurses, the Nurse Leadership Board has extensive knowledge of the multiple myeloma treatment and care landscape. These resources were developed by their team.

Last Medical Content Review: November 4, 2021

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