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 |
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 |