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

• Published in: Mayo Clinic proceedings Vol. 84; no. 12; pp. 1095 - 1110
• Main Authors: Kumar, Shaji K., MD, Mikhael, Joseph R., MD, Buadi, Francis K., MD, Dingli, David, MD, PhD, Dispenzieri, Angela, MD, Fonseca, Rafael, MD, Gertz, Morie A., MD, Greipp, Philip R., MD, Hayman, Suzanne R., MD, Kyle, Robert A., MD, Lacy, Martha Q., MD, Lust, John A., MD, PhD, Reeder, Craig B., MD, Roy, Vivek, MD, Russell, Stephen J., MD, PhD, Short, Kristen E. Detweiler, RN, CNP, Stewart, A. Keith, MD, Witzig, Thomas E., MD, Zeldenrust, Steven R., MD, PhD, Dalton, Robert J., MD, Rajkumar, S. Vincent, MD, Bergsagel, P. Leif, MD
• Format: Journal Article Conference Proceeding
• Language: English
• Published: England Elsevier Inc 01-12-2009; Elsevier, Inc; Elsevier Limited; Mayo Foundation for Medical Education and Research
• Subjects: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor - genetics; Cancer; Care and treatment; Diagnosis; Humans; Internal Medicine; Multiple myeloma; Multiple Myeloma - pathology; Multiple Myeloma - therapy; Patient outcomes; Practice guidelines (Medicine); Practice Guidelines as Topic; Review; Risk Assessment; Stem Cell Transplantation; United States; PR; time to progression; SCT; melphalan-prednisone; MP plus thalidomide; TRM; overall response rate; MPT; MPV; thalidomide; PCLI; dex; overall survival; vincristine, Adriamycin (doxorubicin), dex; monoclonal gammopathy of undetermined significance; MGUS; PFS; immunomodulatory drug; MM; multiple myeloma; Mayo Stratification of Myeloma and Risk-Adapted Therapy; stem cell transplant; MP; conventional chemotherapy; thal; melphalan, prednisone, and bortezomib; high-dose melphalan; treatment-related mortality; fluorescence in situ hybridization; SMM; IMiD; plasma cell labeling index; smoldering MM; event-free survival; ORR; HDM; TTP; EFS; International Staging System; VGPR; nCR; partial response; dexamethasone; OS; near-CR; progression-free survival; ISS; complete response; mSMART; CR; CCT; FISH; VAD; very good PR
• ISSN: 0025-6196; 1942-5546
• DOI: 10.4065/mcp.2009.0603

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.