Management of Newly Diagnosed Symptomatic Multiple Myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines

Abstract

Multiple myeloma is a malignant plasma cell neoplasm that affects more than 20,000 people each year and is the second most common hematologic malignancy. It is part of a spectrum of monoclonal plasma cell disorders, many of which do not require active therapy. During the past decade, considerable progress has been made in our understanding of the disease process and factors that influence outcome, along with development of new drugs that are highly effective in controlling the disease and prolonging survival without compromising quality of life. Identification of well-defined and reproducible prognostic factors and introduction of new therapies with unique modes of action and impact on disease outcome have for the first time opened up the opportunity to develop risk-adapted strategies for managing this disease. Although these risk-adapted strategies have not been prospectively validated, enough evidence can be gathered from existing randomized trials, subgroup analyses, and retrospective studies to develop a working framework. This set of recommendations represents such an effort-the development of a set of consensus guidelines by a group of experts to manage patients with newly diagnosed disease based on an interpretation of the best available evidence.

Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management

“…Approximately 2% of patients with multiple myeloma have true non-secretory disease and have no evidence of an M protein on any of the above studies [6]. Bone marrow studies at the time of initial diagnosis should include fluorescent in situ hybridization (FISH) designed to detect t(11;14), t(4;14), t(14;16), t(6;14), t(14;20), hyperdiploidy, and deletion 17p (see Risk-Stratification below) [21]. Conventional karyotyping to detect hypodiploidy and deletion 13 has value, but if FISH studies are done, additional value in initial risk-stratification is limited.…”

“…A risk-stratification model that relies on a number of independent molecular cytogenetic markers to assess disease aggressiveness is useful for both counseling and therapeutic decision-making [32]. At the Mayo Clinic, newly diagnosed myeloma is stratified into standard-, intermediate-, and high-risk disease using the Mayo stratification for myeloma and risk-adapted therapy (mSMART) classification (Table II) [21,33]. Patients with standard-risk myeloma have a median overall survival (OS) of 6-7 years while those with high-risk disease have a median OS of less than 2-3 years despite tandem autologous stem cell transplantation (ASCT) [1].…”

Diagnosis and Management of Waldenström Macroglobulinemia: Mayo Stratification of Macroglobulinemia and Risk-Adapted Therapy (mSMART) Guidelines

“…This approach is integral to the Mayo Stratification of Macroglobulinemia and Risk-Adapted Therapy (mSMART) (Figure 1; see also www.mSMART.org). 12,13 The specific criteria given in Table 1 are used to classify patients into 3 distinct risk categories but are not intended to replace existing prognostic systems. Instead, these guidelines represent an attempt to offer a simplified, primarily evidence-based algorithm for making treatment decisions for patients with Waldenström macroglobulinemia.…”

The High Cost of Cancer Drugs and What We Can Do About It

“…Mayo Clinic Proceedings has published numerous articles highlighting the current treatment of cancer. [13][14][15][16][17] Most cancers are not curable, and most approved cancer drugs work only for a limited time. When one treatment fails, the patient will be treated with subsequent agents until all options are exhausted.…”