Current Hematologic Malignancy Reports

, Volume 14, Issue 3, pp 187–196 | Cite as

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

  • M. OffidaniEmail author
  • M. Boccadoro
  • F. Di Raimondo
  • M. T. Petrucci
  • P. Tosi
  • M. Cavo
Multiple Myeloma (P Kapoor, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Multiple Myeloma


Purpose of Review

A working group of six expert physicians convened to assess the spectrum of multiple myeloma relapse presentations, discussed the features that can define the disease as aggressive and not aggressive, and established whether this information could help in selecting treatment together with the characteristics of disease and of patients and type of prior therapy.

Recent Findings

The working group agreed that relapse should be distinguished between biochemical and clinical according to IMWG. Moreover, the expert panel defined “aggressive disease” as a clinical condition that requires therapy able to induce a rapid and as deep as possible response to release symptoms and to avoid impending danger of new events. According to this definition, relapse was considered aggressive if it presents with at least one of the following features: doubling of M protein rate over 2 months, renal insufficiency, hypercalcemia, extramedullary disease, elevated LDH, high plasma cell proliferative index, presence of plasma cells in peripheral blood, or skeletal-related complications. Moreover, the panel agreed that this classification can be useful to choose therapy in first relapse together with other patient, disease, and prior therapy characteristics. So, this item was included in a new therapeutic algorithm.


The treatment choice in MM at relapse is wider than in the past with the availability of many new therapeutic regimens leading to increased diversity of approaches and relevant risk of inappropriate treatment decisions. A practical classification of relapses into aggressive or non-aggressive, included in a decisional algorithm on MM management at first relapse, could help to make the appropriate treatment decisions.


Multiple myeloma Refractory plasma cell malignancy Aggressive myeloma Management of relapsed myeloma 


Compliance with Ethical Standards

Conflict of Interest

M. Boccadoro, M. Cavo, F. Di Raimondo, M. Offidani, M.T. Petrucci, and P. Tosi declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • M. Offidani
    • 1
    Email author
  • M. Boccadoro
    • 2
  • F. Di Raimondo
    • 3
  • M. T. Petrucci
    • 4
  • P. Tosi
    • 5
  • M. Cavo
    • 6
  1. 1.Clinica di EmatologiaA.O.U. Ospedali Riuniti di AnconaAnconaItaly
  2. 2.Myeloma Unit, Division of Hematology, University of TorinoAzienda Ospedaliero-Universitaria Città della Salute e della Scienza di TorinoTorinoItaly
  3. 3.Division of Hematology, AOU Policlinico-OVEUniversity of CataniaCataniaItaly
  4. 4.Department of Cellular Biotechnologies and HematologySapienza University of RomeRomeItaly
  5. 5.Hematology UnitInfermi Hospital RiminiRiminiItaly
  6. 6.Institute of Hematology Seragnoli, DIMESUniversity of BolognaBolognaItaly

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