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New Diagnostic Guidelines for Myeloma

Experts revise international staging system

The International Myeloma Foundation (IMF) has announced the publication of revised guidelines for the International Staging System (ISS), which is used to assess the progression of myeloma in new patients and to determine the appropriate course of treatment. The revisions were published in the Journal of Clinical Oncology (JCO)

The update is the result of data collection and analysis by the International Myeloma Working Group (IMWG), the IMF’s research arm. The IMWG consists of approximately 200 leading myeloma researchers from around the world who collaborate on projects designed to provide a more-durable remission for myeloma patients, to improve treatment options, and to generate diagnostic systems and guidelines that prolong lives.

“The revised staging system can be used by doctors to discuss prognostic results very carefully with individual patients,” said Dr. Brian G. M. Durie, IMF and IMWG Chairman. “It’s helpful to know the expectations and to consider how treatments can be modified based on the new ISS system.”

The revised guidelines add tests for chromosomal abnormalities (CA) and serum lactate dehydrogenase (LDH) to the earlier ISS to refine its prognostic value in newly diagnosed myeloma patients. This updating of the myeloma classification system is part of a larger revolution in the diagnosis and treatment of myeloma –– a shift toward biomarkers that are increasingly more sensitive and specific, according to Durie.

While the existing ISS relies on tests for serum beta 2 microglobulin and serum albumin to divide patients into three risk-factor stages, the JCO paper recommends adding interphase fluorescence in situ hybridization (iFISH) to check for CA, along with separate tests for heightened LDH. The two new tests determine more definitively whether a patient is in stage III, while conversely, per the new protocols, a stage I patient would have normal chromosomes and LDH. 

Different combinations of these tests were tried before settling on the recommended refinement, the paper reports. The result is a stronger separation between the three strata of predicted risk for a patient, as determined by algorithms that consider all of the aforementioned tests. 

The report was authored by 32 IMWG myeloma researchers from around the globe. Data from 4,445 newly diagnosed myeloma patients enrolled in 11 international trials were pooled.

Sources: International Myeloma Foundation; August 5, 2015; and JCO; August 3, 2015.

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