Multiple myeloma: 2013 update on diagnosis, risk-stratification, and management.

Research output: Contribution to journalArticle

Abstract

DISEASE OVERVIEW: Multiple myeloma accounts for approximately 10% of hematologic malignancies. DIAGNOSIS: The diagnosis requires 10% or more clonal plasma cells on bone marrow examination or a biopsy proven plasmacytoma plus evidence of associated end-organ damage. In addition, the presence of 60% or more clonal plasma cells in the marrow is also considered as myeloma regardless of the presence or absence of end-organ damage. RISK STRATIFICATION: In the absence of concurrent trisomies, patients with 17p deletion, t(14;16), and t(14;20) are considered to have high-risk myeloma. Patients with t(4;14) translocation are considered intermediate-risk. All others are considered as standard-risk. RISK-ADAPTED INITIAL THERAPY: Standard-risk patients can be treated with lenalidomide plus low-dose dexamethasone (Rd), or a bortezomib-containing triplet such as bortezomib, cyclophosphamide, dexamethasone (VCD). Intermediate-risk and high-risk patients require a bortezomib-based triplet regimen. In eligible patients, initial therapy is given for approximately 4 months followed by autologous stem cell transplantation (ASCT). Standard-risk patients can opt for delayed ASCT if stem cells can be cryopreserved. In patients are not candidates for transplant, initial therapy is given for approximately 12-18 months. MAINTENANCE THERAPY: After initial therapy, lenalidomide maintenance is considered for standard-risk patients who are not in very good partial response or better, while maintenance with a bortezomib-based regimen should be considered in pateints with intermediate or high-risk myeloma. 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.

Original languageEnglish (US)
Pages (from-to)226-235
Number of pages10
JournalAmerican Journal of Hematology
Volume88
Issue number3
StatePublished - Mar 2013

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Risk Management
Multiple Myeloma
Stem Cell Transplantation
Plasma Cells
Dexamethasone
Maintenance
Bone Marrow Examination
Therapeutics
Recurrence
Plasmacytoma
Trisomy
Hematologic Neoplasms
Drug Combinations
Disease Management
Cyclophosphamide
Stem Cells
Bone Marrow
Transplants
Biopsy
Bortezomib

ASJC Scopus subject areas

  • Hematology

Cite this

Multiple myeloma : 2013 update on diagnosis, risk-stratification, and management. / Rajkumar, S. Vincent.

In: American Journal of Hematology, Vol. 88, No. 3, 03.2013, p. 226-235.

Research output: Contribution to journalArticle

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