International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma
Kumar S (1), Paiva B (2), Anderson KC (3), Durie B (4), Landgren O (5), Moreau P (6), Munshi N (3), Lonial S (7), Bladé J (8), Mateos MV (9), Dimopoulos M (10), Kastritis E (10), Boccadoro M (11), Orlowski R (12), Goldschmidt H (13), Spencer A (14), Hou J (15), Chng WJ (16), Usmani SZ (17), Zamagni E ((18), Shimizu K (19), Jagannath S (20), Johnsen HE (21), Terpos E (10), Reiman A (22), Kyle RA (23), Sonneveld P (24), Richardson PG (3), McCarthy P (25), Ludwig H (26), Chen W (27), Cavo M (18), Harousseau JL (6), Lentzsch S (28), Hillengass J (13), Palumbo A (29), Orfao A (9), Rajkumar SV (23), San Miguel J (2), Avet-Loiseau H (30).
(1) Division of Hematology, Mayo Clinic, Rochester, MN, USA.
(2) Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain.
(3) Dana-Farber Cancer Institute, Boston, MA, USA.
(4) Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA.
(5) Memorial Sloan Kettering Cancer Center, New York, NY, USA.
(6) University Hospital, Nantes, France.
(7) Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
(8) Hospital Clinic, Barcelona, Spain.
(9) University Hospital of Salamanca/IBSAL, Salamanca, Spain.
(10) Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece.
(11) Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Torino, Italy; Mount Sinai Cancer Institute, New York, NY, USA.
(12) MD Anderson Comprehensive Cancer Center, Houston, TX, USA.
(13) Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.
(14) The Alfred Hospital, Melbourne, VIC, Australia.
(15) Chang Zheng Hospital, Shanghai, China.
(16) National University Health System, Singapore.
(17) Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA.
(18) Seragnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
(19) Tokai Central Hospital, Kakamigahara, Japan.
(20) Mount Sinai Cancer Institute, New York, NY, USA.
(21) Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.
(22) Dalhousie University Medical School, Dalhousie, Nova Scotia, Canada.
(23) Division of Hematology, Mayo Clinic, Rochester, MN, USA.
(24) Erasmus Medical Center, Rotterdam, Netherlands.
(25) Roswell Park Cancer Institute, Buffalo, NY, USA.
(26) Wilhelminenspital Der Stat Wien, Vienna, Austria.
(27) Beijing Chaoyang Hospital, Beijing, China.
(28) Columbia University, New York, NY, USA.
(29) Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Torino, Italy.
(30) University of Toulouse, Toulouse, France.
Treatment of multiple myeloma has substantially changed over the past decade with the introduction of several classes of new effective drugs that have greatly improved the rates and depth of response.
Response criteria in multiple myeloma were developed to use serum and urine assessment of monoclonal proteins and bone marrow assessment (which is relatively insensitive).
Given the high rates of complete response seen in patients with multiple myeloma with new treatment approaches, new response categories need to be defined that can identify responses that are deeper than those conventionally defined as complete response. Recent attempts have focused on the identification of residual tumour cells in the bone marrow using flow cytometry or gene sequencing. Furthermore, sensitive imaging techniques can be used to detect the presence of residual disease outside of the bone marrow.
Combining these new methods, the International Myeloma Working Group has defined new response categories of minimal residual disease negativity, with or without imaging-based absence of extramedullary disease, to allow uniform reporting within and outside clinical trials.
In this Review, we clarify several aspects of disease response assessment, along with endpoints for clinical trials, and highlight future directions for disease response assessments.
CITATION Lancet Oncol. 2016 Aug;17(8):e328-46. doi: 10.1016/S1470-2045(16)30206-6