Abstract
Risk Stratification in Multiple Myeloma: Putting the Pieces Together.
Highlights
C ontemporary treatments have greatly extended survival in multiple myeloma (MM), and when relapse occurs, clinicians have numerous effective options at their disposal
Genetic profiling of the tumor allows for risk stratification that guides treatment selection
Clinicians will look for serum immunoglobulins (IgA, IgG, IgM), serum free light chains, and beta2 microglobulin, and will perform radiographs and a bone marrow biopsy
Summary
C ontemporary treatments have greatly extended survival in multiple myeloma (MM), and when relapse occurs, clinicians have numerous effective options at their disposal. “Survival is improving, thanks to new treatments,” according to Angela Mayo, MS, PA-C. The proteasome inhibitors—bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro, the new oral agent)—and the immunomodulating drugs (IMiDs)—thalidomide (Thalomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst)—“have revolutionized treatment,” she said. Lytic lesions, compression fractures, unexplained osteoporosis, pancytopenia, renal failure, and hypercalcemia, Ms Mayo said. “Many patients, can be asymptomatic at diagnosis,” she added. Monoclonal gammopathy of unknown significance (MGUS) is defined on bone marrow biopsy by < 10% monoclonal plasma cells in an asymptomatic patient. Rate of progression is 1-2% per year, and risk is cumulative, she said
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