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Cited by 144Multiple Myeloma Research and TreatmentsBone health and treatmentsLymphoma Diagnosis and Treatment

Multiple myeloma: 2012 update on diagnosis, risk-stratification, and management

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Rajkumar, S. Vincent·2012·American Journal of Hematology
DOI 10.1002/ajh.22237PMC PMC3629949
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Abstract

Disease overview: Multiple myeloma accounts for ∼10% of all hematologic malignancies. Diagnosis: The diagnosis requires 10% or more clonal plasma cells on bone marrow examination or a biopsy proven plasmacytoma plus evidence of end‐organ damage felt to be related to the underlying plasma‐cell disorder. Risk stratification: Patients with 17p deletion, t(14;16), t(14;20), or high‐risk gene expression profiling signature have high‐risk myeloma. Patients with t(4;14) translocation, karyotypic deletion 13, or hypodiploidy are considered to have intermediate‐risk disease. All others are considered to have standard‐risk myeloma. Risk‐adapted therapy: Standard‐risk patients are treated with nonalkylator‐based therapy such as lenalidomide plus low‐dose dexamethasone (Rd) followed by autologous stem‐cell transplantation (ASCT). An alternative strategy is to continue initial therapy after stem‐cell collection, reserving ASCT for first relapse. Intermediate‐risk and high‐risk patients are treated with a bortezomib‐based induction followed by ASCT and then bortezomib‐based maintenance. Patients not eligible for ASCT can be treated with Rd for standard risk disease, or with a bortezomib‐based regimen if intermediate‐risk or high‐risk features are present. To reduce toxicity, when using bortezomib, the once‐weekly subcutaneous dose is preferred; similarly, when using dexamethasone, the low‐dose approach (40 mg once a week) is preferred, unless there is a need for rapid disease control. Management of refractory disease: Patients with indolent relapse can be treated first with two‐drug or three‐drug combinations. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. The most promising new agents in development are pomalidomide and carfilizomib. Am. J. Hematol., 2012. © 2011 Wiley Perodicals, Inc.

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  • KRd instead of VRd can be used as initial therapy in patients with t(4;14), t(14;16), t(14;20), and those with ≥2 high-risk abnormalities based on phase 2 studies suggesting higher complete response rates and minimal residual disease negativity rates compared with historical results using VRd.

    “KRd instead of VRd can be used as initial therapy in patients with t(4;14), t(14;16), t(14;20), and those with ≥2 high-risk abnormalities based on the results of phase 2 studies suggesting higher complete response (CR) rates and minimal residual disease negativity rates compared with historical results using VRd [28,30,31].”

    From Epidemiology, Staging, and Management of Multiple Myeloma (2021) · cites this paper as [28]

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  • Patients with high-risk MM do poorly with conventional treatment options and are encouraged to participate in clinical trials that employ novel therapeutic strategies.

    “Patients with a high risk of MM do poorly with conventional treatment options and are therefore encouraged to participate in clinical trials that employ novel therapeutic strategies.”

    From Epidemiology, Staging, and Management of Multiple Myeloma (2021) · cites this paper as [28]

    The Risk-Stratification section reports median overall survival of less than 2–3 years for high-risk patients despite tandem autologous stem-cell transplantation, supporting the poor-outcomes portion of the claim. The paper recommends aggressive treatment for high-risk patients, but the passages reviewed do not encourage them generally to enter clinical trials of novel strategies; its clinical-trial recommendation concerns frontline allogeneic transplantation. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Outside of a clinical trial, VRd remains the preferred choice of initial chemotherapy for patients with high-risk MM who are not candidates for HCT.

    “Outside of a clinical trial, VRd remains the preferred choice of initial chemotherapy for patients with high-risk MM who are not candidates for HCT [28,29].”

    From Epidemiology, Staging, and Management of Multiple Myeloma (2021) · cites this paper as [28]

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Authors
Rajkumar, S. V.
Affiliations
Mayo Clinic (US)
Corresponding author
Rajkumar, S. Vincent
ORCID
Rajkumar, S. Vincent
Venue
American Journal of Hematology
Publisher
Wiley
Published
2011-12-17
Volume
87
Issue
1
Pages
78-88
ISSN
  • 0361-8609 (ISSN-L)
  • 1096-8652
DOI
10.1002/ajh.22237
PMC
PMC3629949
OpenAlex
W2164357850
Cited by
144
References
0
Citations by year
2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 6 · 2019: 5 · 2018: 5 · 2017: 13 · 2016: 10 · 2015: 18 · 2014: 14 · 2013: 37 · 2012: 25
FWCI
16.90
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • American Journal of Hematology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (R01CA107476)
Topics
  • Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
  • Health Sciences › Medicine › Oncology › Bone health and treatments
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
Keywords
multiple myeloma, diagnosis, risk stratification, 17p deletion, gene expression profiling, lenalidomide, dexamethasone, autologous stem cell transplantation, bortezomib, maintenance therapy, relapsed/refractory multiple myeloma, pomalidomide, carfilzomib, target organ damage
MeSH terms
Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Combined Modality Therapy, Humans, Middle Aged, Multiple Myeloma, Recurrence, Risk, Transplantation, Autologous, Hematopoietic Stem Cell Transplantation, Maintenance Chemotherapy

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