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Experts Publish Updated Criteria for Diagnosing Multiple Myeloma

Guidelines allow treatment before organ damage occurs

The International Myeloma Working Group (IMWG) has updated its criteria for diagnosing multiple myeloma. An article outlining the new criteria was published in the November 2014 issue of Lancet Oncology.

“Our group, which includes more than 180 myeloma researchers worldwide, has updated the definition of multiple myeloma for diagnostic purposes to include validated biomarkers in addition to the current clinical symptoms used for diagnosis, which include elevated blood calcium levels, kidney failure, anemia, and bone lesions,” said lead author S. Vincent Rajkumar, MD, a hematologist at the Mayo Clinic in Rochester, Minnesota.

Rajkumar said multiple myeloma is always preceded sequentially by two asymptomatic conditions, monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). However, since MGUS and SMM are both asymptomatic conditions, most myeloma patients are not diagnosed until after they have experienced organ damage.

“The new IMWG criteria allow the diagnosis of myeloma to be made in patients without symptoms and before organ damage occurs, using validated biomarkers that identify patients with SMM who have an ‘ultra-high’ risk of progression to multiple myeloma,” Rajkumar said. “These biomarkers are associated with the near-inevitable development of clinical symptoms and are important for early diagnosis and treatment, which is very important for patients.”

Rajkumar said other updates to the criteria used to diagnose multiple myeloma include the use of computerized tomography (CT) alone or CT combined with positron emission tomography (PET) to identify bone lesions, which will allow more-accurate diagnosis and intervention before fractures or other serious problems arise.

“We believe that the new criteria will rectify the situation where we were unable to use the considerable advances in multiple myeloma therapy prior to organ damage. We can now initiate therapy in some patients early on in the course of their disease,” Rajkumar said.

Source: Mayo Clinic; October 26, 2014.

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