Expert Panel Consensus Statement for Proper Evaluation of First Relapse in Multiple Myeloma.

Area of Science:

• Hematology
• Oncology
• Clinical Medicine

Background:

• Multiple myeloma (MM) relapse management is complex due to diverse presentations and numerous treatment options.
• Distinguishing between aggressive and non-aggressive relapse is crucial for effective therapeutic decision-making.

Purpose of the Study:

• To assess multiple myeloma relapse presentations and define criteria for aggressive disease.
• To establish if classifying relapse as aggressive or non-aggressive can aid in treatment selection for MM.
• To integrate this classification into a therapeutic algorithm for first relapse management.

Main Methods:

• A working group of six expert physicians convened to discuss and define features of aggressive vs. non-aggressive multiple myeloma relapse.
• Established criteria for aggressive relapse, including rapid M protein doubling, renal insufficiency, hypercalcemia, extramedullary disease, elevated LDH, high plasma cell proliferation, circulating plasma cells, or skeletal complications.
• Incorporated this classification into a new therapeutic algorithm for MM management at first relapse.

Main Results:

• Defined aggressive multiple myeloma relapse based on specific clinical indicators.
• Agreed that classifying relapse as aggressive or non-aggressive, alongside patient, disease, and prior therapy characteristics, is useful for treatment selection.
• Developed a new therapeutic algorithm incorporating this classification to guide MM management at first relapse.

Conclusions:

• A practical classification of multiple myeloma relapses into aggressive or non-aggressive categories is beneficial.
• This classification, integrated into a decisional algorithm, can help mitigate the risk of inappropriate treatment decisions in MM first relapse.
• The classification aids in selecting appropriate therapies by considering disease characteristics, patient factors, and prior treatment history.