![]() ![]() ![]() Numerous clinical trials provide data on best practices along the spectrum of the disease. These changes in diagnosis, staging, and response assessment have been made necessary by the rapid advances in treatment of the MM, with the arrival of several new drugs (carfilzomib, pomalidomide, daratumumab, elotuzumab, panobinostat, ixazomib, and selinexor). ![]() Updated IMWG response criteria include definitions for minimal residual disease (MRD) negativity 4. The current IMWG staging system for MM incorporates tumor burden and high-risk cytogenetics, and is referred to as the Revised International Staging System 3. The International Myeloma Working Group (IMWG) diagnostic criteria for MM require 10% or more clonal plasma cells in the bone marrow (and/or a biopsy proven plasmacytoma) plus any one or more myeloma defining events (MDE): end-organ damage (hypercalcemia, renal insufficiency, anemia, or bone lesions) attributable to the underlying plasma-cell disorder, bone marrow clonal plasma cells ≥60%, serum involved to uninvolved free light chain (FLC) ratio ≥100 (provided involved FLC level is ≥100 mg/L), or more than 1 focal lesion (5 mm or more in size) on magnetic resonance imaging (MRI) 2. Major changes have occurred in the diagnostic criteria, staging system, response criteria, and treatment for multiple myeloma (MM) in the last decade 1. In all patients, clinical trials should be considered first, prior to resorting to the standard of care algorithms we outline. Each algorithm has been designed to facilitate easy decision-making for practicing clinicians. We have relied on data from randomized controlled trials whenever possible, and when appropriate trials to guide therapy are not available, our recommendations reflect best practices based on non-randomized data, and expert opinion. In this paper, we provide algorithms for the treatment of newly diagnosed and relapsed MM based on the best available evidence. High-risk MM is defined by the presence of t(4 14), t(14 16), t(14 20), gain 1q, del(17p), or p53 mutation. In addition, another key variable that affects treatment strategy is risk stratification of patients into standard and high-risk MM. Along the disease course, the choice of specific therapy is affected by many variables including age, performance status, comorbidities, and eligibility for stem cell transplantation. The treatment of multiple myeloma (MM) continues to evolve rapidly with arrival of multiple new drugs, and emerging data from randomized trials to guide therapy. ![]()
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