Multiple myeloma: 2011 update on diagnosis, risk-stratification, and management

Authors

Errata

This article is corrected by:

  1. Errata: Multiple myeloma: 2011 update on diagnosis, risk-stratification, and management by S. Vincent Rajkumar Am. J. Hematol. 2011;86:57–65, DOI: 10.1002/ajh.21913Multiple myeloma: 2012 update on diagnosis, risk-stratification, and management by S. Vincent Rajkumar Am. J. Hematol. 2012;87:79–88, DOI: 10.1002/ajh.22237Multiple myeloma: 2013 update on diagnosis, risk-stratification, and management by S. Vincent Rajkumar Am. J. Hematol. 2013;88:225–235, DOI: 10.1002/ajh.23474 Volume 89, Issue 6, 669, Article first published online: 20 May 2014

  • Conflict of interest: Nothing to report

Abstract

Disease overview:

Multiple myeloma is malignant plasma-cell disorder that accounts for ∼∼10% of all hematologic malignancies.

Diagnosis:

The diagnosis requires (1) 10% or more clonal plasma cells on bone marrow examination or a biopsy-proven plasmacytoma plus (2) evidence of end-organ damage felt to be related to the underlying plasma cell disorder.

Risk stratification:

Patients with 17p deletion, t(4;14), t(14;16), t(14;20), and karyotypic deletion 13 or hypodiploidy are considered to have high-risk myeloma. All others are considered to have standard-risk disease.

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). If patients are tolerating the induction regimen treatment well, an alternative strategy is to continue initial therapy after stem-cell collection, reserving ASCT for first relapse. 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 a bortezomib-based regimen if high-risk features are present. To reduce toxicity, when using bortezomib, the once-weekly 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 lenalidomide, bortezomib, or alkylators plus low-dose corticosteroids. 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. 86:57–65, 2011. © 2010 Wiley-Liss, Inc.

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