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Expert Panel Consensus Statement for Proper Evaluation of First Relapse in Multiple Myeloma

  • Multiple Myeloma (P Kapoor, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

A working group of six expert physicians convened to assess the spectrum of multiple myeloma relapse presentations, discussed the features that can define the disease as aggressive and not aggressive, and established whether this information could help in selecting treatment together with the characteristics of disease and of patients and type of prior therapy.

Recent Findings

The working group agreed that relapse should be distinguished between biochemical and clinical according to IMWG. Moreover, the expert panel defined “aggressive disease” as a clinical condition that requires therapy able to induce a rapid and as deep as possible response to release symptoms and to avoid impending danger of new events. According to this definition, relapse was considered aggressive if it presents with at least one of the following features: doubling of M protein rate over 2 months, renal insufficiency, hypercalcemia, extramedullary disease, elevated LDH, high plasma cell proliferative index, presence of plasma cells in peripheral blood, or skeletal-related complications. Moreover, the panel agreed that this classification can be useful to choose therapy in first relapse together with other patient, disease, and prior therapy characteristics. So, this item was included in a new therapeutic algorithm.

Summary

The treatment choice in MM at relapse is wider than in the past with the availability of many new therapeutic regimens leading to increased diversity of approaches and relevant risk of inappropriate treatment decisions. A practical classification of relapses into aggressive or non-aggressive, included in a decisional algorithm on MM management at first relapse, could help to make the appropriate treatment decisions.

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Authors and Affiliations

  1. Clinica di Ematologia, A.O.U. Ospedali Riuniti di Ancona, via Conca, 71, 60126, Ancona, Italy

    M. Offidani

  2. Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy

    M. Boccadoro

  3. Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy

    F. Di Raimondo

  4. Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy

    M. T. Petrucci

  5. Hematology Unit, Infermi Hospital Rimini, Rimini, Italy

    P. Tosi

  6. Institute of Hematology Seragnoli, DIMES, University of Bologna, Bologna, Italy

    M. Cavo

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Offidani, M., Boccadoro, M., Di Raimondo, F. et al. Expert Panel Consensus Statement for Proper Evaluation of First Relapse in Multiple Myeloma. Curr Hematol Malig Rep 14, 187–196 (2019). https://doi.org/10.1007/s11899-019-00507-x

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