TY - CHAP M1 - Book, Section TI - Multiple Myeloma A1 - Lin, Paul A1 - Kaufman, Gregory P. A1 - Lee, Hans C. A1 - Manasanch, Elisabet E. A1 - Becnel, Melody A1 - Thomas, Sheeba A1 - Weber, Donna A1 - Orlowski, Robert Z. A1 - Patel, Krina A2 - Kantarjian, Hagop M. A2 - Wolff, Robert A. A2 - Rieber, Alyssa G. PY - 2022 T2 - The MD Anderson Manual of Medical Oncology, 4e AB - KEY CONCEPTSThe updated International Myeloma Working Group (IMWG) criteria for multiple myeloma includes patients with bone marrow plasmacytosis of at least 60%, an involved-to-uninvolved serum-free light-chain ratio of at least 100, or more than one focal lesion on magnetic resonance imaging (MRI) studies of at least 5 mm in size in addition to the criteria of hypercalcemia, renal disease, anemia, and bone disease (CRAB).The IMWG now recommends advanced imaging, such as whole-body low-dose computed tomography (CT), positron emission tomography–computed tomography (PET-CT), or MRI to evaluate for bone disease because it can detect up to 80% more lesions compared with plain film radiographs.Triplet therapies, such as with a proteasome inhibitor, immunomodulatory drugs, and steroids have shown significant improvement over doublet therapy. Ongoing trials are investigating quadruplet therapy, with promising initial results, and they could become standard of care in the future.As of 2020, autologous transplant after induction chemotherapy remains the standard of care and has shown significant improvement in progression-free survival. This might change in the future depending on disease risk status, and minimal residual disease testing.Maintenance therapy after autologous transplant is recommended because it has been shown to significantly improve progression-free survival.As of 2020, there is no indication to treat patients with smoldering myeloma. However, this could change in the future, because recent trials have shown that treatment of high-risk smoldering myeloma can potentially delay its progression to myeloma. SN - PB - McGraw Hill Education CY - New York, NY Y2 - 2024/03/19 UR - accessmedicine.mhmedical.com/content.aspx?aid=1190833707 ER -