Dr. Wolf on the Treatment of High-Risk Patients With Multiple Myeloma

Jeffrey Wolf, MD, clinical professor, Department of Medicine, director, Myeloma Program, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the treatment approach for patients with high-risk multiple myeloma.

Early evidence suggests that maintenance therapy after autologous stem cell transplant makes a difference, especially in high-risk patients. Using lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone for several years may convert high-risk patients to standard-risk patients. That has been reflected in the new staging system.

The International Staging System used albumin and beta-2 microglobulin to identify who was stage III or high risk. Physicians now require an elevated beta-2 microglobulin as well as either an elevated lactic acid dehydrogenase or 1 of the several abnormal fluorescence in situ hybridization tests that predict for high risk. This would be 17p deletion, t(4;14) or t(14;16). The revised International Staging System seems to better predict for high risk than the original International Staging System.