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A Continuing Medical Education Series
Multiple myeloma: 2012 update on diagnosis, risk-stratification, and management†
Article first published online: 17 DEC 2011
Copyright © 2011 Wiley Periodicals, Inc.
American Journal of Hematology
Volume 87, Issue 1, pages 78–88, January 2012
How to Cite
Rajkumar, S. V. (2012), Multiple myeloma: 2012 update on diagnosis, risk-stratification, and management. Am. J. Hematol., 87: 78–88. doi: 10.1002/ajh.22237
- Issue published online: 16 DEC 2011
- Article first published online: 17 DEC 2011
- Manuscript Accepted: 20 OCT 2011
- Manuscript Received: 19 OCT 2011
Vol. 87, Issue 4, 452, Article first published online: 13 MAR 2012
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
Vol. 89, Issue 6, 669, Article first published online: 20 MAY 2014
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.