EHA 2015

New definition for multiple myeloma improves patient outcomes

Prof Vincent Rajkumar - Mayo Clinic, Rochester, USA

In the case of multiple myeloma we’ve been hearing at the EHA meeting in Vienna that there are a few changes, new agents coming up. But first of all what about this idea of the definition of the disease, what is happening there?

Myeloma is unique among cancers in the sense that until last year a patient needed to have end organ damage, hypercalcaemia, renal failure, anaemia or bone lesions in order to be called as myeloma. We have had a paradigm shift in that in the sense that from last year the International Myeloma Working Group published a manuscript in which we redefined multiple myeloma. Now myeloma can be diagnosed before end organ damage can happen by using sensitive biomarkers.

Which ones?

The three specific biomarkers are bone marrow plasma cell percentage 60% or more, free light chain ratio of 100 or more or more than one focal lesion on MRI scan. In addition the new criteria clarify some of the old ones including the definition of bone disease and the definition of renal failure and allows the use of modern imaging such as PET-CTs, MRIs and whole body CT scans to making the diagnosis early. I think this will improve the outcome of patients.

How is this impacting the work of busy cancer doctors right now?

I think these are changes that cancer doctors have wanted for a very long time so actually the reception has been amazing. Most people have been waiting for these changes to happen and it brings myeloma in line with other malignancies.

In terms of outcomes, how much difference is this likely to make?

I think it will make a huge outcome difference because we’ve previously been waiting for the other shoe to drop off. For example, patients who are at very high risk of renal failure, we would just wait for the renal failure to happen before we called the myeloma. Now it gives us an opportunity to prevent that.