Review of advancements in treating Multiple Myeloma (MM)

The Bottom Line: New diagnostic criteria, a Revised International Staging System, and the approval of three drugs (four others pending approval) have greatly advanced the treatment, diagnosis, staging, risk-stratification and management of MM. These changes, as well as others detailed in this article, have altered how MM and smoldering multiple myeloma (SMM) are defined.

Reference: Rajkumar, S. Vincent. Myeloma today: Disease definitions and treatment advances. Am J Hematology. 2015 Nov 13; (Accepted article). doi: 10.1002/ajh.24236.

Summary: This review article takes you through the advancements in great detail, including an explanation of the old regimen and how the advances came to be. New diagnostic criteria involve three biomarkers: bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain ratio ≥100, and >1 focal lesion on magnetic resonance imaging.

The Revised International Staging System “combines markers of tumor burden (albumin, beta-2 microglobulin) with markers of aggressive disease biology (high risk cytogenetics and elevated serum lactate dehydrogenase).”

The approval of  carfilzomib, pomalidomide, and panobinostat (elotuzumab, daratumumab, and ixazomib are pending approval) combined with the older agents (cyclophosphamide, dexamethasone, thalidomide, bortezomib, and lenalidomide)  “dramatically increases the repertoire of regimens” available for treatment at each stage.