DIAGNOSTIC AND RESPONSE CRITERIA

Chairmen: Hervé Avet-Loiseau, S. Vincent Rajkumar 

New Diagnostic Criteria for Multiple Myeloma 

S. Vincent Rajkumar

Revised IMWG criteria (MGUS, SMM, MM) – implications:

1. MRI, PET-CT, or wb CT needed in all patients with SMM or solitary Plasmocytoma

2. High risk SMM: needs close follow up to detects MM before serious CRAB features

   - rFLC

   - Creatinine clearance

   - Imaging

3. Judgement

    - rFLC >100 with low urine M protein

   - rFLC <100 for many years

   - MRI focal lesions: equivocal, <5mm, or 1 lesion

4. Paradigm shift, improved QOL, improved outcome, potential for cure

 

SLIDES

 

Risk Assessment and Stratification

Rafael Fonseca[nbsp]

Lessons learned:

-       Genomic instability is bad

-       Precision medicine works best in stable genomes (combinations?)

-       Fragmentation (e.g. translocation) and mutation worse than whole chromosome gains losses

-       More important than any biomarker

-       Bad prognostic biomarkers = GI

SLIDES

 

Geriatric Assessment and Stratification

Alessandra Larocca

“New” stratification of myeloma patients

Patient status assessment:

Age (score 0-1-2) Charlson (score 0-1), ADL (score 0-1), IADL (score 0-1)

FIT

Additive total score = 0

INTERMEDIATE

Additive total score = 0

FRAIL

Additive total score = 2

Full-dose

Full-dose

Reduced-dose

TRIPLET REGIMENS

VMP

MPT
ASCT

DOUBLET REGIMENS

Rd

Vd

Doublet regimens

rd

vd

Palliative

 

Elderly algorithm

1. ICT application: www.myelomafrailtyscorecalculator.net

2. Definition of fit- intermediate – frail (5-7 min effort with advantage of reducing risk of AEs)

 

SLIDES