Newly Diagnosed Multiple Myeloma: Cytogenetic Classification and Evidence-Based Therapy Guidelines
Multiple myeloma is a neoplastic plasma cell dyscrasia that on a yearly basis affects nearly 17,000 individuals and kills more than 11,000. Survival of patients with multiple myeloma varies from months to decades.
Although no cure exists, many effective treatments are available that prolong survival and improve the quality of life of patients with this disease. The purpose of Mayo Stratification of Myeloma and Risk-Adapted Therapy is to offer a simplified, evidence-based algorithm of decision making for patients with newly diagnosed myeloma. Although a multitude of risk factors including age, tumor burden, renal function, lactate dehydrogenase, β2-microglobulin, and serum albumin, identified throughout the years our group has now recognized and endorsed a genetic stratification and patient functional status for treatment. The focal point of our strategy revolves around risk stratification.
Mayo Stratification of Myeloma and Risk-Adapted Therapy
Rather than promulgating any one specific prognostic system, we have focused our efforts on defining a composite high-risk group that we believe should be managed differently from standard-risk patients. The treatment guidelines for patients are:
- Indications for therapy for newly diagnosed myeloma
- Initial therapy for patients ineligible for stem cell transplantation
- Induction therapy for patients eligible for transplantation
- Timing of stem cell collection in patients eligible for stem cell transplantation
- Consolidation therapy for patients eligible for stem cell transplantation
- Stem cell transplantation in elderly patients and patients with renal failure undergoing hemodialysis
- Maintenance therapy for patients ineligible for stem cell transplantation
- Maintenance therapy after autologous stem cell transplantation
- Maintenance therapy for high-risk patients after bortezomib-based consolidation therapy
- Managing thrombotic risk in patients receiving thalidomide and lenalidomide-based therapy
Cytogenetic classification systems are readily applied in the clinic. Nearly all patients with myeloma have abnormal chromosomes by fluorescence in situ hybridization (FISH), including deletions, aneuploidy, and translocations, although abnormal karyotypes are seen in only 18%-30% of cases using standard metaphase analysis.