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2024 update on diagnosis, risk stratification, and treatment of patients with multiple myeloma
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Multiple myeloma accounts for 1% of all cancers and 10% of all hematologic malignancies, with an annual age-adjusted incidence rate of 4 per 100,000 in the US.1 A 2024 update on the diagnosis, risk stratification, and management of patients with multiple myeloma was published in the American Journal of Hematology by Rajkumar.1 |
| Key learnings |
| The updated IMWG guidelines require ≥10% clonal plasma cells plus evidence of ≥1 MDE, CRAB features, and three specific biomarkers, ≥60% clonal bone marrow plasma cells, serum FLC ratio ≥100, and ≥1 focal lesion detected by MRI. Incorporating these biomarkers enables an earlier diagnosis and allows treatment before organ damage occurs. |
| The RISS and Mayo Clinic mSMART risk stratification incorporate tumor burden, high-risk cytogenetic markers, and elevated lactate dehydrogenase levels to identify high-risk patients and guide therapeutic strategies. |
| For TE patients with NDMM, the initial treatment option includes Dara-VRd or Isa-VRd, followed by auto-HSCT. For TI patients with NDMM, the initial treatment option includes either VRd or DRd if they are frail and Dara-VRD or Isa-VRD if they are not frail. |
| Lenalidomide maintenance is the standard of care for most patients, while high-risk patients benefit from a combination of bortezomib and lenalidomide. |
| Treatment for patients with RRMM is based on several factors, including the timing of relapse, response to prior therapy, aggressiveness of the relapse, and performance status. |
Abbreviations: auto-HSCT, autologous hematopoietic stem cell transplantation; CRAB, hypercalcemia, renal failure, anemia, or lytic bone lesions; Dara-VRd, daratumumab, bortezomib, lenalidomide, dexamethasone; DRd, daratumumab, lenalidomide, dexamethasone; FLC, free light chain; IMWG, International Myeloma Working Group; Isa-VRd, isatuximab, bortezomib, lenalidomide, dexamethasone; MDE, myeloma-defining event; MRI, magnetic resonance imaging; NDMM, newly diagnosed multiple myeloma; RISS, revised International Staging System; RRMM, relapsed/refractory multiple myeloma; TE, transplant-eligible; TI, transplant-ineligible; VRd, bortezomib, lenalidomide, dexamethasone.
- Rajkumar SV. Multiple myeloma: 2024 update on diagnosis, risk-stratification, and management. Am J Hematol. 2024;99(9):1802-1824. DOI: 1002/ajh.27422
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