New criteria for diagnosing multiple myeloma

Volume 4, Issue 1, 2015

Summary

Validated biomarkers allow diagnosis before organ damage occurs.

Photograph of Vincent S. Rajkumar, M.D.

Vincent S. Rajkumar, M.D.

The International Myeloma Working Group (IMWG) has updated the criteria for diagnosing multiple myeloma and published the new criteria in The Lancet Oncology.

"Our group, which includes more than 180 myeloma researchers worldwide, has updated the definition of multiple myeloma for diagnostic purposes to include validated biomarkers in addition to the current clinical symptoms used for diagnosis, which include elevated blood-calcium levels, kidney failure, anemia and bone lesions," said Vincent S. Rajkumar, M.D., a hematologist at the Mayo Clinic Cancer Center and lead author of the multiple myeloma journal article.

Multiple myeloma, a type of blood cancer, is always preceded by two asymptomatic conditions — first monoclonal gammopathy of undetermined significance (MGUS) and then smoldering multiple myeloma (SMM).

Because MGUS and smoldering multiple myeloma are both asymptomatic conditions, most people are not diagnosed with multiple myeloma until organ damage has already occurred. MGUS and smoldering myeloma are usually detected by chance when a patient has a routine blood test or other tests for a different medical issue.

"The new IMWG criteria allow for the diagnosis of myeloma to be made in patients without symptoms and before organ damage occurs, using validated biomarkers that identify patients with SMM who have an ultra-high risk of progression to multiple myeloma," Dr. Rajkumar said. "These biomarkers are associated with the near inevitable development of clinical symptoms and are important for early diagnosis and treatment."

Other updates to the criteria used to diagnose multiple myeloma include the use of CT scans and PET-CT scans to identify bone lesions. These tests will enable more accurate diagnosis and intervention, potentially before fractures or other serious complications occur.

"We believe that the new criteria will rectify the situation where we were unable to use the considerable advances in multiple myeloma therapy prior to organ damage," Dr. Rajkumar said. "We can now initiate therapy in some patients early on in the course of their disease."