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 specific metrics that new biomarkers should meet for inclusion in the disease definition. 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 definition.


S Vincent Rajkumar, Meletios A Dimopoulos, Antonio Palumbo, Joan Blade, Giampaolo Merlini, María-Victoria Mateos, Shaji Kumar, Jens Hillengass, Efstathios Kastritis, Paul Richardson, Ola Landgren, Bruno Paiva, Angela Dispenzieri, Brendan Weiss, Xavier LeLeu, Sonja Zweegman, Sagar Lonial, Laura Rosinol, Elena Zamagni, Sundar Jagannath, Orhan Sezer, Sigurdur Y Kristinsson, Jo Caers, Saad Z Usmani, Juan José Lahuerta, Hans Erik Johnsen, Meral Beksac, Michele Cavo, Hartmut Goldschmidt, Evangelos Terpos, Robert A Kyle, Kenneth C Anderson, Brian G M Durie, Jesus F San Miguel

Lancet Oncol 2014; 15: e538–48

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