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Cited by 789

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Multiple myeloma: 2020 update on diagnosis, risk‐stratification and management

Open access
Rajkumar, S. Vincent·2020·American Journal of Hematology

Abstract

Disease overview: Multiple myeloma accounts for approximately 10% of hematologic malignancies. Diagnosis: The diagnosis requires ≥10% clonal bone marrow plasma cells or a biopsy proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE) namely CRAB (hyper c alcemia, r enal failure, a nemia, or lytic b one lesions) features felt related to the plasma cell disorder, bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain (FLC) ratio ≥100 (provided involved FLC is ≥100 mg/L), or >1 focal lesion on magnetic resonance imaging (MRI). Risk stratification: The presence of del(17p), t(4;14), t(14;16), t(14;20), gain 1q, or p53 mutation is considered high‐risk multiple myeloma. Presence of any two high risk factors is considered double‐hit myeloma; three or more high risk factors is triple‐hit myeloma. Risk‐adapted initial therapy: In transplant eligible patients, induction therapy consists of bortezomib, lenalidomide, dexamethasone (VRd) given for approximately 3‐4 cycles followed by autologous stem cell transplantation (ASCT). In high‐risk patients, daratumumab, bortezomib, lenalidomide, dexamethasone (Dara‐VRd) is an alternative to VRd. Selected standard risk patients can get additional cycles of induction, and delay transplant until first relapse. Patients not candidates for transplant are typically treated with VRd for approximately 8‐12 cycles followed by lenalidomide; alternatively these patients can be treated with daratumumab, lenalidomide, dexamethasone (DRd). Maintenance therapy: After ASCT, standard risk patients need lenalidomide maintenance, while bortezomib‐based maintenance is needed for patients with high‐risk myeloma. Management of refractory disease: Most patients require a triplet regimen at relapse, with the choice of regimen varying with each successive relapse.

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Metadata

Authors
Rajkumar, S. V.
Venue
American Journal of Hematology
Publisher
Wiley
Published
2020-04-13
Volume
95
Issue
5
Pages
548-567
ISSN
  • 0361-8609 (ISSN-L)
  • 1096-8652
OpenAlex
W3013063217
Cited by
789
References
164
FWCI
73.32
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Multiple myeloma: 2020 update on diagnosis, risk‐stratification and management. https://app.cochat.ai/papers/10.1002/ajh.25791
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Rajkumar, S. V. (2020). Multiple myeloma: 2020 update on diagnosis, risk‐stratification and management. American Journal of Hematology. https://doi.org/10.1002/ajh.25791

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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