Promising new drugs are being evaluated for treatment of multiple myeloma (MM), but their impact should be measured against the expected outcome in patients failing current therapies. However, the natural history of relapsed disease in the current era remains unclear. We studied 286 patients with relapsed MM, who were refractory to bortezomib and were relapsed, refractory, or ineligible, to an IMiD (Immunomodulatory Drug), with measurable disease and ECOG PS of 0, 1 or 2. The date patients satisfied the entry criteria was defined as time zero (T0). The median age at diagnosis was 58 years and time from diagnosis to T0 was 3.3 years. Following T0, 213 (74%) patients had a treatment recorded with one or more regimens (median=1; range 0-8). The first regimen contained bortezomib in 55 (26%) patients and an IMiD in 70 (33%). A minor response or better was seen to at least one therapy after T0 in 94 patients (51%) including >=partial response in 69 (38%). The median overall survival and event free survival from T0 were 9 and 5 months respectively. This study confirms the poor outcome once patients become refractory to current treatments. The results provide context for interpreting ongoing trials of new drugs.

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Recent advances in the treatment of multiple myeloma (MM) have increased the need for accurate diagnosis of the disease. The detection of bone and bone marrow lesions is crucial in the work-up of MM, and often dictates the decision to start treatment. Furthermore, detection of minimal residual disease (MRD) is important for prognosis and treatment planning, and has underscored an unmet need for sensitive imaging modalities that accurately assess response to therapy in MM. Low dose whole body computed tomography (WBCT) has increased sensitivity compared to conventional skeletal survey (CSS) in the detection of bone disease, and can reveal information leading to changes in therapy and management that could prevent or delay the onset of significant morbidity and mortality related to skeletal-related events. Given the multiple options for detection of bone and bone marrow lesions ranging from CSS to WBCT, positron emission tomography (PET)-CT, and magnetic resonance imaging (MRI), the International Myeloma Working Group has established guidelines on the optimal and standardized use of imaging modalities in different stages of the disease. These recommendations on imaging within and outside of clinical trials will help to standardize the imaging worldwide in order to allow comparison of results and unification of treatment approaches.

Solitary plasmacytoma is an infrequent form of plasma cell dyscrasia that presents as a single mass of monoclonal plasma cells, located either extramedullary or intraosseous. In some patients, a bone marrow aspiration can detect a low monoclonal plasma cell infiltration which indicates a high risk of early progression to an overt myeloma disease. Before treatment initiation, whole body positron emission tomography–computed tomography or magnetic resonance imaging should be performed to exclude the presence of additional malignant lesions. For decades, treatment has been based on high-dose radiation, but studies exploring the potential benefit of systemic therapies for high-risk patients are urgently needed. In this review, a panel of expert European hematologists updates the recommendations on the diagnosis and management of patients with solitary plasmacytoma.Electronic supplementary materialThe online version of this article (10.1186/s13045-017-0549-1) contains supplementary material, which is available to authorized users.

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