smoldering myeloma cells
Risk Stratification for Smoldering Multiple Myeloma

Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria

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Myeloma Cells
Diagnosis of Myeloma
  • More than 1 focal lesion on MRI
  • Clonal bone marrow cells ≥ 60%
  • Involved/uninvolved serum free light chain ratio ≥ 100
  • Creatinine clearance < 40 mL/min
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Role of Imaging

Newer imaging techniques can be used to enhance diagnosis and monitoring.

Whole-body low-dose CT is much more sensitive than conventional skeletal survey.

Read more:
Whole-body computed tomography versus conventional skeletal survey in patients with multiple myeloma: a study of the International Myeloma Working Group

Whole body FDGPET/CT is ideal for whole-body screening and assessment of residual disease and/or potential early relapse.

Read more:
Role of FDGPET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group

MRI is broadly important at both diagnosis and for monitoring, especially if PET/CT is not feasible or available.

Read more:
Role of Magnetic Resonance Imaging in the Management of Patients With Multiple Myeloma: A Consensus Statement

nurse with patient
Treatment for the Newly Diagnosed

The treatment for newly diagnosed myeloma has really changed over the past 10 years. The mSMART algorithms give an accessible snapshot of the current recommendations for transplant-eligible and -ineligible patients with standard, intermediate, or high-risk disease.

 

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Relapse and Minimal Residual Disease (MRD) Assessment

Treatment of multiple myeloma has substantially changed over the past decade with the introduction of several classes of new effective drugs that have greatly improved the rates and depth of response. Response criteria in multiple myeloma were developed to use serum and urine assessment of monoclonal proteins and bone marrow assessment (which is relatively insensitive). Given the high rates of complete response seen in patients with multiple myeloma with new treatment approaches, new response categories need to be defined that can identify responses that are deeper than those conventionally defined as complete response. Recent attempts have focused on the identification of residual tumour cells in the bone marrow using flow cytometry or gene sequencing. Furthermore, sensitive imaging techniques can be used to detect the presence of residual disease outside of the bone marrow. Combining these new methods, the International Myeloma Working Group has defined new response categories of minimal residual disease negativity, with or without imaging-based absence of extramedullary disease, to allow uniform reporting within and outside clinical trials. 

Listen to Dr. Shaji Kumar's podcast

Published: August, 2016 | DOI:https://doi.org/10.1016/S1470-2045(16)30206-6

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Role of Bone-Modifying Agents in Multiple Myeloma: American Society of Clinical Oncology Clinical Practice Guideline Update

The goal of this update is to provide oncologists, hematologists, other health care practitioners, patients, and caregivers with recommendations regarding the role of bone-modifying agents in multiple myeloma.

Kenneth Anderson, Nofisat Ismaila, Patrick J. Flynn, Susan Halabi, Sundar Jagannath, Mohammed S. Ogaily, Jim Omel, Noopur Raje, G. David Roodman, Gary C. Yee, and Robert A. Kyle

Journal of Clinical Oncology 2018 36:8, 812-818 

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Dr. Brian Durie's Best of ASH

 

Dr. Brian G.M. Durie discusses key takeaways from the annual conference and explains how this new and important information relates to myeloma patients, caregivers, and other members of the myeloma community.

ASH is the American Society of Hematology. This annual conference welcomed more than 30,000 healthcare professionals from around the world this past December, 2018.

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