Multiple Myeloma (MM) is a malignancy characterized by the infiltration of clonal plasma cells in the bone marrow that secrete a monoclonal protein in the majority of patients. Several new therapies have been approved for the treatment of myeloma in the last decade, with a resultant improvement in outcome.
However, considerable heterogeneity exists in the survival outcomes among patients diagnosed with MM. Although a large number of prognostic markers have been described in MM, none of them completely explain the heterogeneity seen in this disease and attempts have been made to develop systems using several of these prognostic factors to better risk stratify patients with MM. To complicate matters further, some of the new treatment appears to overcome the high-risk defined by one or more of these prognostic factors. With the increased treatment options, the ability of some treatment to overcome certain risk factors and the availability of markers to define risk categories, the question of risk stratification in the management of myeloma is becoming an important issue. Development of a uniform risk stratification system will also allow better comparison of patient groups across different trials, given the heterogeneity seen in the outcomes.
During the International Myeloma Working Group (IMWG) Meeting in London in 2011 June, a group was convened to discuss issues around risk stratification in MM. In particular, the following were discussed in the context of evolving treatment paradigms and prognostic factors:
(1) What defines high-risk and low-risk patients?
(2) What should we use to define the risk groups?
(3) Can risk-adapted therapy be recommended at this time?
(4) What are the best trial designs for risk stratification?
In the following sections, we shall discuss current evidence and arguments for risk stratification in myeloma based on the above questions and discussions. We will then present our consensus recommendations at the end. Some of these recommendations will be applicable clinically, whereas others will be for research and design of clinical trials as we continue to optimize management of myeloma patients.
Original languageEnglish
Pages (from-to)269-277
Publication statusPublished - 5 Feb 2014

    Research areas

  • myeloma

ID: 2382567