title: Time to redefine Myeloma.
abstract: In November 2014 the International Myeloma Working Group (IMWG) revised the definition of multiple myeloma, such that asymptomatic patients with newly diagnosed multiple myeloma without any of the traditional 'CRAB' (hypercalcaemia, renal impairment, anaemia, bone disease) end organ damage criteria but with one of three new criteria would be recommended to start treatment. Previously, the standard of care for such patients was expectant management. These three new criteria are: greater than 60% clonal plasma cells on bone marrow biopsy, a serum free light chain (sFLC) ratio of >100 (the involved sFLC must be >100 mg/l) and greater than one unequivocal focal lesion on advanced imaging (low dose whole body computerized tomography, magnetic resonance imaging, (18) F fluorodeoxyglucose positron emission tomography). Although this would appear to affect a small number of patients, the impact of these changes are broad, leading to an increased use of advanced imaging, a debate around the management of patients previously diagnosed with smouldering myeloma, changed terminology and clinical trial design and an extension of the use of biomarkers. For the first time the philosophy of treatment in myeloma will change from treatment initiation only being triggered by overt end organ damage to an era where sub clinical risk factors will also be taken into account.
authors.affiliation: School of Cancer Sciences, University of Birmingham, Birmingham, UK.|Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Guy
authors.initials: G
authors.lastname: Pratt
authors.affiliation: Department of Haematology, King's College Hospital NHS Foundation Trust, Princess Royal Hospital, London, UK.
authors.forename: Stella
authors.initials: S
authors.lastname: Bowcock
authors.affiliation: Department of Oncology, University of Sheffield Medical School, Sheffield, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chantry
authors.affiliation: Department of Haematology, St James's University Hospital, Leeds, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
authors.affiliation: Department of Haematology, University of Newcastle, Newcastle, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Jackson
authors.affiliation: Myeloma UK, Edinburgh, UK.
authors.forename: Maggie
authors.initials: M
authors.lastname: Lai
authors.affiliation: Myeloma UK, Edinburgh, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Low
authors.affiliation: Department of Radiology, Kings College Hospital, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mulholland
authors.affiliation: HMDS Laboratory, Leeds General Infirmary, Leeds, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Owen
authors.affiliation: Department of Haematology, University College London, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Rabin
authors.affiliation: Department of Haematology, Oxford University Hospitals NHS Trust and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ramasamy
authors.affiliation: Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Snowden
authors.affiliation: Department of Haematology, Guys and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Streetly
authors.affiliation: National Amyloidosis Centre, University College London, London, UK.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Wechalekar
authors.affiliation: Department of Haematology, University College London, London, UK.
authors.forename: Kwee
authors.initials: K
authors.lastname: Yong
authors.affiliation: Department of Haematology, University Hospitals Bristol Foundation Trust, Bristol, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Bird
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D006801:Humans; D009101:Multiple Myeloma / Q000145:classification* / Q000000981:diagnostic imaging* / Q000378:metabolism*; D011859:Radiography
chemical_list: D014408:Biomarkers, Tumor
keywords: imaging; multiple myeloma; prognostic markers; smouldering myeloma