Natural history of relapsed myeloma, refractory to immunomodulatory drugs and proteasome inhibitors: A multicenter IMWG study

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Introduction of new myeloma therapies offers new options for patients refractory to immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs). In this multicenter study, patients with relapsed multiple myeloma, who have received at least three prior lines of therapy, are refractory to both an IMiD (lenalidomide or pomalidomide) and a PI (bortezomib or carfilzomib), and have been exposed to an alkylating agent were identified. The time patients met the above criteria was defined as time zero (T0). Five hundred and forty-three patients diagnosed between 2006 and 2014 were enrolled in this study. Median age at T0 was 62 years (range 31-87); 61% were males. The median duration between diagnosis and T0 […]

Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group

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The International Myeloma Working Group consensus aimed to provide recommendations for the optimal use of 18fluorodeoxyglucose (18F-FDG) PET/CT in patients with multiple myeloma and other plasma cell disorders, including smouldering multiple myeloma and solitary plasmacytoma. 18F-FDG PET/CT can be considered a valuable tool for the work-up of patients with both newly diagnosed and relapsed or refractory multiple myeloma because it assesses bone damage with relatively high sensitivity and specificity, and detects extramedullary sites of proliferating clonal plasma cells while providing important prognostic information. The use of 18F-FDG PET/CT is mandatory to confirm a suspected diagnosis of solitary plasmacytoma, provided that whole-body MRI is unable to be performed, and to distinguish […]

Second primary malignancies in multiple myeloma: an overview and IMWG consensus

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Therapeutic advancements following the introduction of autologous stem cell transplantation and novel agents have significantly improved clinical outcomes for patients with multiple myeloma (MM). Increased life expectancy, however, has led to renewed concerns about the long-term risk of second primary malignancies (SPMs). This review outlines the most up-to-date knowledge of possible host-, disease-, and treatment-related risk factors for the development of SPMs in patients with MM, and provides practical recommendations to assist physicians. Authors: P. Musto K. C. Anderson M. Attal P. G. Richardson A. Badros J. Hou R. Comenzo J. Du B. G. M. Durie J. San Miguel H. Einsele W. M. Chen L. Garderet G. Pietrantuono J. Hillengass […]

International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma

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The updated criteria for the diagnosis of myeloma represent a paradigm shift in the approach to myeloma and have considerable impact on the management of the disease. For decades the diagnosis of multiple myeloma required the presence of end-organ damage known as the CRAB criteria, including increased calcium level, renal dysfunction, anemia, and destructive bone lesions. The updated criteria allow for treatment of patients who are at such high risk of progression to symptomatic disease that it is clear they would benefit from therapy and also potentially live longer if they were treated before serious organ damage occurred. The revised IMWG criteria allow, in addition to the classic CRAB features, […]

International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment

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Recommendations developed by the International Myeloma Working Group (IMWG), the research arm of the IMF, were published online in the Journal of Clinical Oncology on March 14, 2016. The recommendations are based on data gathered through December 2015 and analyzed by Meletios A. Dimopoulos, MD, from the University of Athens in Greece, and colleagues.

Gene signature combinations improve prognostic stratification of multiple myeloma patients

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Multiple myeloma (MM) is a plasma cell neoplasm with significant molecular heterogeneity. Gene expression profiling (GEP) has contributed significantly to our understanding of the underlying biology and has led to several prognostic gene signatures. However, the best way to apply these GEP signatures in clinical practice is unclear. In this study, we investigated the integration of proven prognostic signatures for improved patient risk stratification. Three publicly available MM GEP data sets that encompass newly diagnosed as well as relapsed patients were analyzed using standardized estimation of nine prognostic MM signature indices and simulations of signature index combinations. Cox regression analysis was used to assess the performance of simulated combination indices. Taking the average of multiple GEP signature indices was a simple but highly effective way of integrating multiple GEP signatures. Furthermore, although adding more signatures in general improved performance substantially, we identified a core signature combination, EMC92+HZDCD, as the top-performing prognostic signature combination across all data sets. In this study, we provided a rationale for gene signature integration and a practical strategy to choose an optimal risk score estimation in the presence of multiple prognostic signatures.

Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group

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The clinical outcome of multiple myeloma (MM) is heterogeneous. A simple and reliable tool is needed to stratify patients with MM. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed MM (NDMM). Authors: Antonio Palumbo, Herv Avet-Loiseau, Stefania Oliva, Henk M. Lokhorst, Hartmut Goldschmidt, Laura Rosinol, Paul Richardson, Simona Caltagirone, Juan Jos Lahuerta, Thierry Facon, Sara Bringhen, Francesca Gay, Michel Attal, Roberto Passera, Andrew Spencer, Massimo Offidani, Shaji Kumar, Pellegrino Musto, Sagar Lonial, Maria T. Petrucci, Robert Z. Orlowski, Elena Zamagni, Gareth Morgan, […]

Geriatric assessment predicts survival and toxicities in elderly myeloma: an International Myeloma Working Group report

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The IMF’s research arm, the International Myeloma Working Group (IMWG), published an important new study on the assessment of elderly myeloma patients in the journal Blood. In the paper, the IMWG introduces a scoring system developed to classify the frailty of elderly patients. The international study, which analyzed data from more than 850 newly diagnosed patients, found that the IMWG frailty score predicted mortality and the risk of toxicity in elderly myeloma patients. The frailty score could be a helpful tool in better assessing patients and providing them with more suitable therapies. Authors: Antonio Palumbo, Sara Bringhen, Maria-Victoria Mateos, Alessandra Larocca, Thierry Facon, Shaji K. Kumar, Massimo Offidani, Philip McCarthy, […]

Role of Magnetic Resonance Imaging in the Management of Patients With Multiple Myeloma: A Consensus Statement

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The IMF’s research division, the International Myeloma Working Group (IMWG), published guidelines in the Journal of Clinical Oncology on the use of MRI (magnetic resonance imaging) in myeloma. The IMWG guidelines recommend that all patients with smoldering or asymptomatic myeloma undergo whole-body MRI, or spine and pelvic MRI if whole body MRI is not available. This recommendation is in sync with the IMWG’s “New Diagnostic Criteria” for myeloma, published in November in the Lancet Oncology, in which the presence of more than one MRI lesion is identified as a basis for considering starting full anti-myeloma therapy. The guidelines note that MRI at diagnosis of symptomatic patients (based upon presence of […]

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

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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 […]