Editorial Volume 15 Issue 3 - January 2020 DOI: 10.19080/CTOIJ.2020.15.555913 Cancer Ther Oncol Int J Copyright © All rights are reserved by Nahla A M Hamed Update in treatment of Symptomatic newly Diagnosed Transplant Eligible Multiple Myeloma Patients Nahla A M Hamed* Professor of Clinical Hematology, Hematology Department, Faculty of Medicine, Alexandria University, Egypt Submission: December 09, 2019; Published: January 22, 2020 * Correspondence Author: Nahla A M Hamed, Professor of Clinical Hematology, Hematology Department, Faculty of Medicine, Alexandria University, Egypt Cancer Ther Oncol Int J 15(3): CTOIJ.MS.ID.555913 (2020) 0096 Cancer Therapy & Oncology International Journal ISSN: 2473-554X Introduction The updated criteria for multiple myeloma (MM) diagnosis requires evidence of either 10% or more clonal plasma cells in bone marrow examination or a biopsy-proven plasmacytoma in addition to the presence of one or more myeloma defining events (MDE). MDE consists of established CRAB features (hypercalcemia, renal failure, anemia, or lytic bone lesions) as well as 3 specific biomarkers: clonal bone marrow plasma cells ≥60%, serum free light chain (FLC) ratio ≥100 (provided involved FLC level is ≥100 mg/L), and more than one focal lesion on MRI [1]. Important considerations in myeloma diagnosis i. The levels of monoclonal (M) proteins and FLC in blood are assessed routinely to confirm active disease [2]. The M protein is considered measurable if it is ≥1 g/dL in the serum. The serum FLC assay is particularly useful in patients who lack a measurable M protein, provided that the FLC ratio is abnormal and the involved FLC level is ≥100 mg/L [1]. ii. The evaluation of M-protein in urine is less widespread across clinical practice [2]. The M protein is considered measurable if it is ≥200 mg/day in the urine [1]. iii. Routine bone marrow assessment (aspirate or biopsy) remains key in the establishment of MM diagnosis in clinical practice, as reflected in the updated International Myeloma Working Group (IMWG) diagnostic criteria [2]. iv. The creatinine clearance test or estimated glomerular filtration rate (calculated using either the Modification of Diet in Renal Disease [MDRD] study or Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equations) are also performed at diagnosis to assess renal function [2]. v. Skeletal surveys using X ray do not reveal lytic bone disease until 70% of the bone has decalcified [3]. Whole body low dose computed tomography (CT) or magnetic resonance imaging (MRI) is now recommended by the European Myeloma Network (EMN) and the IMWG as standard for the detection of lytic or focal lesions. Both are more sensitive than conventional skeletal survey using X ray for detecting bone disease [2]. MRI of the spine and pelvis are particularly valuable for detection of focal lesions and may be used if whole body imaging is not available [3]. Abstract This article tries to answer the following questions i. Is it necessary to incorporate cytogenetic risk categorization in induction decision making? ii. What are the criteria used to assess eligibility for autologous stem-cell transplant (ASCT)? iii. The role of tandem transplantation iv. The role of consolidation and maintenance therapy today v. Is the use of MRD assessment have any role after transplant? Keywords: PET-CT: Positron Emission-Computed Tomography; NDMM: Newly Diagnosed Multiple Myeloma; MDE: Myeloma Defining Events; IMWG: International Myeloma Working Group; ASCT: Autologous Stem-Cell Transplant; FLC: Free Light Chain; CAs: Chromosomal Abnormalities; ISS: International Staging System; LDH: Lactate Dehydrogenase