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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.
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:
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.