International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma

Abstract

This International Myeloma Working Group consensus updates the disease defi nition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identifi cation of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients. In addition to this change, we clarify and update the underlying laboratory and radiographic variables that fulfi l the criteria for the presence of myeloma-defi ning CRAB features, and the histological and monoclonal protein requirements for the disease diagnosis. Finally, we provide specifi c metrics that new biomarkers should meet for inclusion in the disease defi nition. The International Myeloma Working Group recommends the implementation of these criteria in routine practice and in future clinical trials, and recommends that future studies analyse any diff erences in outcome that might occur as a result of the new disease defi nition.

Ibrutinib alone or with dexamethasone for relapsed or relapsed and refractory multiple myeloma: phase 2 trial results

“…Key inclusion criteria included measurable, symptomatic MM according to International Myeloma Working Group (IMWG) criteria (Durie et al , 2006); RRMM after receiving ≥2 lines of therapy (including a PI or IMiD), including lack of response or disease progression (according to IMWG response criteria; Rajkumar et al , 2014) to the most recent line of therapy; and Eastern Cooperative Oncology Group (ECOG) performance status ≤1. Key exclusion criteria were an absolute neutrophil count <0·75 × 10 9 /l; platelet count <50 × 10 9 /l; creatinine level >221 μmol/l; peripheral neuropathy grade ≥2; and a need for concomitant warfarin or other vitamin K antagonists or strong CYP3A4/5 inhibitors (Indiana University Department of Medicine 2016).…”

Whole body magnetic resonance imaging in newly diagnosed multiple myeloma: early changes in lesional signal fat fraction predict disease response

“…Using iterative decomposition of water and fat with echo asymmetric and least‐squares estimation (IDEAL) Dixon‐based MRI, Takasu et al (2015) demonstrated a significant decrease in sFF in the lumbar spine in symptomatic myeloma patients, when compared with asymptomatic multiple myeloma. We have chosen to concentrate our analysis on FL because the presence of FL is recognized to be more relevant (compared to diffuse marrow signal abnormality) to disease pathogenesis and risk assignment (Rajkumar et al , 2014), hence signal changes in these diseased areas are likely to be more prognostically relevant. To the best of our knowledge, our work is the first to systematically examine changes in the sFF of FLs following initiation of treatment in newly diagnosed MM patients, to report significant increases in sFF after 8 weeks of treatment and the potential utility of early sFF changes as a predictor of depth of response to induction chemotherapy.…”

“…The use of cross‐sectional imaging techniques [computed tomography (CT), positron emission tomography (PET)‐CT and MRI] are confirmed to be more sensitive than plain radiography in the detection of bone lesions (Zamagni et al , 2007; Bartel et al , 2009; Regelink et al , 2013; Waheed et al , 2013). Importantly, the detection of more than one focal lesion (FL) on cross‐sectional imaging is now considered to fulfill the criteria for symptomatic disease deserving of treatment (Rajkumar et al , 2014). Furthermore, advanced imaging techniques have also been described to have clinical utility in prognostication.…”

Monoclonal Gammopathy of Undetermined Significance and Multiple Myeloma in Older Adults

“…The diagnostic criteria for MM, SMM, and MGUS were recently updated (Box 1). 20 If a monoclonal protein is not detected on serum or urine studies, then MM is extremely unlikely and most plasma cell diseases can usually be confidently excluded from consideration; nonsecretory myeloma (ie, MM that does not secrete monoclonal protein) does exist but is rare. 21 If a monoclonal protein is detected, then the patient needs additional work-up to clarify the diagnosis.…”