Updated criteria for diagnosis and risk stratification in patients with multiple myeloma

Search and disclosure of most adequate diagnostic criteria and prognostic indicators of disease represents one of the most difficult tasks in the understanding of any disease, which creates the way toward a more successful treatment and longer survival. The recent advances in research techniques that have helped refine the diagnostic work up and prognosis of myeloma include serum-free light chains, especially in oligosecretory myeloma, magnetic resonance and positron emission tomography in the diagnosis of bone diseases, cytogenetics and fluorescent in situ hibridization (FISH) technique to determine prognosis. The International Staging System and Durie/Salmon PLUS system are the current standards for staging myeloma. Newer risk stratification protocols are based on international staging system and chromosomal changes detected by conventional cytogenetics and FISH. These improved predictive risk stratification models have enabled the determination of prognosis in patients with myeloma which has a considerable influence on the choice of therapeutic algorism. Novel therapies enable a significant increase in achieving complete remission in a significant number of patients which also results in the definition of more precise criteria regarding the response to therapy. A firm and complete remission with a very good partial remission represent new categories defined by the international uniform criteria of response to therapy. This paper provides the current criteria for diagnosis, staging, risk stratification and response assessment of myeloma.