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IMWG consensus on risk stratification in multiple myeloma

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Multiple myeloma is characterized by underlying clinical and biological heterogeneity, which translates to variable response to treatment and outcome. With the recent increase in treatment armamentarium and the projected further increase in approved therapeutic agents in the coming years, the issue of having some mechanism to dissect this heterogeneity and rationally apply treatment is coming to the fore. A number of robustly validated prognostic markers have been identified and the use of these markers in stratifying patients into different risk groups has been proposed. In this consensus statement, the International Myeloma Working Group propose well-defined and easily applicable risk categories based on current available information and suggests the use of […]

IMWG Consensus Statement Regarding the Current Status of Allogeneic Stem Cell Transplantation for Multiple Myeloma

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There has been much controversy in over two decades about the role of allogeneic stem cell transplant in myeloma. Early studies conducted in Europe and at the Fred Hutchinson Cancer Center in Seattle, WA, consistently demonstrated high treatment-related mortality (TRM) of approximately 45% in heavily patients receiving full myeloablative allogeneic transplant (full allo). Overall survival rates in these studies were generally less than 30% at five years. Full allo in myeloma patients was therefore largely abandoned worldwide in the early 1990s. There were, however, some long-term remission durations among patients treated within one year of diagnosis, after a single line of therapy, and with chemotherapy-sensitive disease. In fact, there was […]

Renal Impairment in Patients With Multiple Myeloma: A Consensus Statement on Behalf of the International Myeloma Working Group

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Renal impairment is a common complication of multiple myeloma (MM). The estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula is the recommended method for the assessment of renal function in patients with MM with stabilized serum creatinine. In acute renal injury, the RIFLE (risk, injury, failure, loss and end-stage kidney disease) and Acute Renal Injury Network criteria seem to be appropriate to define the severity of renal impairment. Novel criteria based on eGFR measurements are recommended for the definition of the reversibility of renal impairment. Rapid intervention to reverse renal dysfunction is critical for the management of these patients, especially for those with light […]

International Myeloma Working Group consensus statement regarding the current status of allogeneic stem-cell transplantation for multiple myeloma

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PURPOSE: To define consensus statement regarding allogeneic stem-cell transplantation (Allo-SCT) as a treatment option for multiple myeloma (MM) on behalf of International Myeloma Working Group. PATIENTS AND METHODS: In this review, results from prospective and retrospective studies of Allo-SCT in MM are summarized. RESULTS: Although the introduction of reduced-intensity conditioning (RIC) has lowered the high treatment-related mortality associated with myeloablative conditioning, convincing evidence is lacking that Allo-RIC improves the survival compared with autologous stem-cell transplantation. CONCLUSION: New strategies are necessary to make Allo-SCT safer and more effective for patients with MM. Until this is achieved, Allo-RIC in myeloma should only be recommended in the context of clinical trials. Authors: Lokhorst […]

Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering (Asymptomatic) Multiple Myeloma: IMWG Consensus Perspectives Risk Factors for Progression and Guidelines for Monitoring and Management

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Monoclonal gammopathy of undetermined significance (MGUS) was identified in 3.2% of 21,463 residents of Olmsted County, Minnesota, 50 years of age or older. The risk of progression to multiple myeloma, Waldenstrom’s macroglobulinemia, AL amyloidosis or a lymphoproliferative disorder is approximately 1% per year. Low- risk MGUS is characterized by having an M protein < 15 g/L, IgG type and a normal free light chain (FLC) ratio. Patients should be followed with serum protein electrophoresis at six months and, if stable, can be followed every two to three years or when symptoms suggestive of a plasma cell malignancy arise. Patients with intermediate and high-risk MGUS should be followed in six months […]

International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100)

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Multiple myeloma is the most common indication for high-dose chemotherapy with autologous stem cell support (ASCT) in North America today. Stem cell procurement for ASCT has most commonly been performed with stem cell mobilization using colony-stimulating factors with or without prior chemotherapy. The target CD34+ cell dose to be collected as well as the number of apheresis performed varies throughout the country, but a minimum of 2 million CD34+ cells/kg has been traditionally used for the support of one cycle of high-dose therapy. With the advent of plerixafor (AMD3100) (a novel stem cell mobilization agent), it is pertinent to review the current status of stem cell mobilization for myeloma as […]

Mobilization in myeloma revisited: IMWG consensus perspectives on stem cell collection following initial therapy with thalidomide-, lenalidomide-, or bortezomib-containing regimens

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The past decade has witnessed a paradigm shift in the initial treatment of multiple myeloma with the introduction of novel agents such as thalidomide, lenalidomide, and bortezomib, leading to improved outcomes. High-dose therapy and autologous stem cell transplantation remains an important therapeutic option for patients with multiple myeloma eligible for the procedure. Before the advent of the novel agents, patients underwent stem cell collection prior to significant alkylating agent exposure, given its potential deleterious effect on stem cell collection. With increasing use of the novel agents in the upfront setting, several reports have emerged raising concerns about their impact on the ability to collect stem cells. An expert panel of […]

The role of vertebral augmentation in multiple myeloma: International Myeloma Working Group Consensus Statement

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There are approximately 20 000 new patients diagnosed with myeloma in the United States each year.1 With the availability of better treatments and resultant improved survival, there are currently close to 100 000 patients living with myeloma in the United States. Similar incidence and prevalence rates exist throughout Europe.2 Of these patients, the spine is affected by osteolytic and/or osteopenic bone disease in 70%.3 Myeloma is the commonest primary cancer affecting the spine. Painful vertebral compression fractures (VCFs) affect approximately 30% of myeloma patients. As myeloma patients live longer, it is especially relevant to provide the best available treatment for pain and reduce disabilities that can result from VCFs.4 The focus of […]