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Am J Hematol. 2011 Jan;86(1):57-65. doi: 10.1002/ajh.21913.

Multiple myeloma: 2011 update on diagnosis, risk-stratification, and management.

Author information

1
Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. rajkumar.vincent@mayo.edu

Erratum in

  • Am J Hematol. 2014 Jun;89(6):669.

Abstract

DISEASE OVERVIEW:

Multiple myeloma is malignant plasma-cell disorder that accounts for ∼10% of all hematologic malignancies.

DIAGNOSIS:

The diagnosis requires (1) 10% or more clonal plasma cells on bone marrow examination or a biopsy-proven plasmacytoma plus (2) evidence of end-organ damage felt to be related to the underlying plasma cell disorder.

RISK STRATIFICATION:

Patients with 17p deletion, t(4;14), t(14;16), t(14;20), and karyotypic deletion 13 or hypodiploidy are considered to have high-risk myeloma. All others are considered to have standard-risk disease.

RISK-ADAPTED THERAPY:

Standard-risk patients are treated with nonalkylator-based therapy such as lenalidomide plus low-dose dexamethasone (Rd) followed by autologous stem-cell transplantation (ASCT). If patients are tolerating the induction regimen treatment well, an alternative strategy is to continue initial therapy after stem-cell collection, reserving ASCT for first relapse. High-risk patients are treated with a bortezomib-based induction followed by ASCT and then bortezomib-based maintenance. Patients not eligible for ASCT can be treated with Rd for standard risk disease or a bortezomib-based regimen if high-risk features are present. To reduce toxicity, when using bortezomib, the once-weekly dose is preferred; similarly, when using dexamethasone, the low-dose approach (40 mg once a week) is preferred, unless there is a need for rapid disease control.

MANAGEMENT OF REFRACTORY DISEASE:

Patients with indolent relapse can be treated first with lenalidomide, bortezomib, or alkylators plus low-dose corticosteroids. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. The most promising new agents in development are pomalidomide and carfilizomib.

PMID:
21181954
DOI:
10.1002/ajh.21913
[Indexed for MEDLINE]
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