Grand Rounds

Updates in the Diagnosis and Monitoring of Multiple Myeloma

Sandra Kurtin,(1) RN, MSN, AOCN®, ANP-C, Page Bertolotti,(2) RN, BSN, OCN®, Kevin Brigle,(3) PhD, NP, and Daniel Verina,(4) BS, BSN, MSN, ACNP-BC, on behalf of the International Myeloma Foundation Nurse Leadership Board

1The University of Arizona Cancer Center, Tuscon, Arizona; 2Cedars-Sinai Medical Center, Los Angeles, California; 3Virginia Commonwealth University, Richmond, Virginia; 4Mount Sinai Medical Center, New York, New York

Sandra Kurtin, RN, MSN, AOCN®, ANP-C, The University of Arizona Cancer Center, 3838 N. Campbell Avenue, Tucson, AZ 85719-1454. E-mail:

J Adv Pract Oncol 2016;7:59–70 | doi: 10.6004/jadpro.2016.7.2.15 | © 2016 Harborside Press®




Multiple myeloma (MM) is a plasma cell neoplasm characterized by malignant transformation and clonal expansion of mature plasma cells, resulting in an overproduction of monoclonal proteins (immunoglobulins). Due to the heterogeneity of the disease, there is wide variability in the disease trajectory and prognosis. To date, MM is considered an incurable disease, and nearly all patients will relapse and require successive lines of therapy to survive. Each relapse is characterized by a lower depth and shorter duration of response. In the absence of a definitive cure, the goal of therapy has been to improve progression-free survival and, in turn, overall survival. However, as patients survive longer and receive continued lines of therapy, it is important to preserve quality of life in these individuals for whom long-term control of disease is the main goal. As such, accurate diagnosis and risk stratification is critical to selecting the best therapy at the time of diagnosis. Early identification of relapse or lack of response to therapy will facilitate changes in therapy to maximize disease control. Early detection of progressive disease and monitoring of adverse events are essential to provide the best therapy over the course of the patient’s disease. The International Myeloma Working Group (IMWG) has recently updated recommendations for the diagnosis and monitoring of MM. Familiarity with the updated IMWG recommendations will provide the advanced practitioner in oncology with the tools for the effective diagnosis, treatment, and monitoring of the MM patient.

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