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Expert Highlights Evolving Approaches for Newly Diagnosed Multiple Myeloma

Gina Columbus @ginacolumbusonc
Published: Tuesday, May 16, 2017

Prashant Kapoor, MD

Prashant Kapoor, MD

Risk stratification for patients with newly diagnosed multiple myeloma is an essential component of the treatment plan, explains expert Prashant Kapoor, MD.

State of the Science Summit on Hematologic Malignancies. In detail, he lectured on the importance of minimal residual disease (MRD) negativity, using IMWG criteria, and pivotal data that have truly changed the landscape.

OncLive: Your talk focused on the clinical approach for patients with newly diagnosed multiple myeloma. What did you highlight?

Kapoor: I started with the revised IMWG classification for multiple myeloma. These are in addition to the original CRAB criteria that we typically use to treat patients. Now, we have 3 additional criteria for starting therapy.

One of the reasons for starting therapy sooner is, nowadays, the treatments are much better tolerated, and they have much better efficacy in contrast to the medications that we had available about a decade ago. 

What are the first steps you take with a patient who has newly diagnosed disease?

When we see a patient in the clinic, 1 of the first steps we do is typically risk stratify patients with myeloma. We want to know whether these patients are high risk or standard risk. The vast majority of patients actually have standard-risk myeloma. The risk stratification is based on certain chromosomal abnormalities. It is important to risk stratify because it not only helps in prognosticating patients, but it also gives us an idea as to how we should treat and approach them, particularly the ones that are transplant eligible. 

What is important to note about staging patients with myeloma?

I did talk about the IMWG, which has recently introduced a new staging system for risk stratification of myeloma. They have piggybacked on the original simple prognostic tool they used, and that was the International Staging System (ISS) introduced first in 2005. Now, more recently, they have integrated some of the cytogenetic abnormalities, in addition to LDH, and these biomarkers that we are now using are commonly used in the community. One can easily stage these patients and risk stratify them. They are not only very good prognostic tools, but we hope that in the future, we will be able to use these staging systems to guide our therapy, as well. 
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