Site Editors

Shaji K. Kumar, MD

Prashant Kapoor, MD, FACP


2023 NCCN Hem: Revisiting Risk Stratification in Newly Diagnosed Myeloma

By: Julia Fiederlein Cipriano, MS
Posted: Wednesday, October 4, 2023

At the recent NCCN Annual Congress: Hematologic Malignancies, Natalie S. Callander, MD, of the University of Wisconsin School of Medicine and Public Health, Madison, explored the revised risk assessment strategies and clinical trial data that may aid in the development of individualized treatment approaches for patients with newly diagnosed multiple myeloma. Although the therapeutic landscape continues to shift toward increased risk adaptability, she emphasized, ongoing efforts should place an emphasis on tackling modifiable risks.

The updated NCCN Guidelines outline the factors considered as high risk for disease progression or relapse in newly diagnosed patients. “[The second revision of the International Staging System] incorporates 1q as a separate factor but also weights if [the patient] has more than one cytogenetic abnormality,” Dr. Callander stated. “We think we will be able to better discriminate based on this kind of risk stratification.” In addition, she provided evidence-based recommendations for patients who are eligible for autologous stem cell transplantation.

Dr. Callander also discussed the use of measurable residual disease (MRD) to assess or modify risk in this patient population. “We have known for a number of years that, no matter what your treatment was initially, if you became MRD-negative, you did better than if you were MRD-positive,” commented Dr. Callander. “We are starting to get some hints about whether there are some interventions that affect MRD.”

Finally, Dr. Callander briefly reviewed the advances in the treatment of elderly patients with multiple myeloma (> age 65) and the need to figure out the best way to treat them. Specifically, the MAIA trial established the regimen of the monoclonal antibody daratumumab plus lenalidomide and dexamethasone (DRd) as “the bar to meet” in the treatment of those who are not eligible for a transplantation because of age or comorbidities, she stated.

Disclosure: Dr. Callander reported no conflicts of interest.

By continuing to browse this site you permit us and our partners to place identification cookies on your browser and agree to our use of cookies to identify you for marketing. Read our Privacy Policy to learn more.