Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

International uniform response criteria for multiple myeloma

A Corrigendum to this article was published on 25 April 2007

A Corrigendum to this article was published on 22 November 2006

Abstract

New uniform response criteria are required to adequately assess clinical outcomes in myeloma. The European Group for Blood and Bone Marrow Transplant/International Bone Marrow Transplant Registry criteria have been expanded, clarified and updated to provide a new comprehensive evaluation system. Categories for stringent complete response and very good partial response are added. The serum free light-chain assay is included to allow evaluation of patients with oligo-secretory disease. Inconsistencies in prior criteria are clarified making confirmation of response and disease progression easier to perform. Emphasis is placed upon time to event and duration of response as critical end points. The requirements necessary to use overall survival duration as the ultimate end point are discussed. It is anticipated that the International Response Criteria for multiple myeloma will be widely used in future clinical trials of myeloma.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. Durie BGM . New approaches to treatment for multiple myeloma: durable remission and quality of life as primary goals . Clin Lymphoma Myeloma 2005 ; 6 : 181 – 190 .

    Article  CAS  Google Scholar 

  2. Rajkumar SV, Dispenzieri A . Evaluation and monitoring of response to therapy in multiple myeloma . Haematologica 2005 ; 90 : 1305 – 1308 .

    PubMed  Google Scholar 

  3. Child JA, Morgan G, Davies F, Owen RG, Bell SE, Hawkins K et al . High-dose chemotherapy with hematopoietic stem cell rescue for multiple myeloma . N Engl J Med 2003 ; 348 : 1875 – 1883 .

    Article  CAS  Google Scholar 

  4. Attal M, Harousseau JL, Facon T, Guilhot F, Doyen C, Fuzibet JG et al . Single versus double autologous stem-cell transplantation for multiple myeloma . N Engl J Med 2003 ; 26 : 2495 – 2502 .

    Article  Google Scholar 

  5. Blade J, Samson D, Reece D, Apperley J, Bjorkstrand B, Gahrton G et al . Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation . Br J Haematol 1998 ; 102 : 1115 – 1123 .

    Article  CAS  Google Scholar 

  6. Durie BGM, Jacobson J, Barlogie B, Crowley J . Magnitude of response with myeloma frontline therapy does not predict outcome: importance of time to progression in Southwest Oncology Group chemotherapy trials . J Clin Oncol 2004 ; 22 : 1857 – 1863 .

    Article  Google Scholar 

  7. Dispenzieri A, Kyle RA, Lacy MQ, Rajkumar SV, Therneau TM, Larson DR et al . POEMS syndrome: definitions and long-term outcome . Blood 2003 ; 101 : 2496 – 2506 .

    Article  CAS  Google Scholar 

  8. International Myeloma Working Group . Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group . Br J Haematol 2003 ; 121 : 749 – 757 .

  9. Greipp PR, San Miguel J, Durie BGM, Crowley J, Barlogie B, Blade J et al . International staging system for multiple myeloma . J Clin Oncol 2005 ; 23 : 3412 – 3420 .

    Article  Google Scholar 

  10. Durie BGM . Staging and kinetics in multiple myeloma . In: Salmon SE (ed). Clinics in Haematology: Myeloma and Related Disorders, Vol. 2, Number 1, WB Saunders Company, Ltd: Alden Press, Ocford, 1982, pp 3 – 18 .

    Google Scholar 

  11. Richardson PG, Barlogie B, Berenson J, Singhal S, Jagannath S, Irwin D et al . A phase II study of bortezomib in relapsed, refractory myeloma . N Engl J Med 2003 ; 348 : 2609 – 2617 .

    Article  CAS  Google Scholar 

  12. Oakervee HE, Popat R, Curry N, Smith P, Morris C, Drake M et al . PAD combination therapy (PS-341/bortezomib, doxorubicin and dexamethasone) for previously untreated patients with multiple myeloma . Br J Haematol 2005 ; 129 : 755 – 762 .

    Article  CAS  Google Scholar 

  13. Drayson M, Tang LX, Drew R, Mead GP, Carr-Smith H, Bradwell AR . Serum free light chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma . Blood 2001 ; 97 : 2900 – 2902 .

    Article  CAS  Google Scholar 

  14. Bradwell AR, Carr-Smith HD, Mead GP, Harvey TC, Drayson MT . Serum testing for assessment of patients with Bence–Jones myeloma . Lancet 2003 ; 361 : 489 – 491 .

    Article  Google Scholar 

  15. Mead GP, Carr-Smith HD, Drayson MT, Morgan GJ, Child A, Bradwell AR . Serum free light chains for monitoring multiple myeloma . Br J Haematol 2004 ; 126 : 348 – 354 .

    Article  CAS  Google Scholar 

  16. Hassoun H, Reich L, Klimek VM, Dhodapkar M, Cohen A, Kewalramani T et al . Doxorubicin and dexmaethasone followed by thalidomide and dexamethasone is an effective well tolerated initial therapy for multiple myeloma . Br J Hematol 2006 ; 132 : 155 .

    Article  CAS  Google Scholar 

  17. Rajkumar SV, Kyle RA, Therneau TM, Melton III LJ, Bradwell AR, Clark RJ et al . Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance . Blood 2005 ; 106 : 812 – 817 .

    Article  CAS  Google Scholar 

  18. Kyle RA, Schreiman JS, McLeod RA, Beabout JW . Computed tomography in diagnosis and management of multiple myeloma and its variants . Arch Int Med 1985 ; 145 : 1451 – 1452 .

    Article  CAS  Google Scholar 

  19. Durie BGM, Waxman AD, D'Angeloa A, William CM . Whole body F-FDG18 PET identifies high-risk myeloma . J Nucl Med 2002 ; 43 : 1457 – 1463 .

    PubMed  Google Scholar 

  20. Durie BGM . Is magnitude of initial response predictive for survival in multiple myeloma? Ann Oncol 1999 ; 2 : 166 – 169 .

    Article  Google Scholar 

  21. Lahuerta JJ, Martinez-Lopez J, de la Serna J, Blade J, Grande C, Alegra A et al . Remission status defined by immunofixation versus electrophoresis following autologus transplantation has a major impact on the outcome of multiple myeloma patients . Br J Haematol 2000 ; 109 : 438 – 446 .

    Article  CAS  Google Scholar 

  22. Riccardi A, Mora O, Tinelli C, Porta C, Danova M, Brugnatelli S et al . Response to first-line chemotherapy and long-term survival in patients with multiple myeloma: results of the MM87 prospective randomized protocol . Eur J Cancer 2003 ; 39 : 31 – 37 .

    Article  CAS  Google Scholar 

  23. Cavo M, Zamagni E, Tosi P, Tacchetti P, Cellini C, Cangini D et al . Superiority of thalidomide and dexamethasone over vincristine–doxorubicin–dexmaethasone (VAD) as primary therapy in preparation for autologous transplantation for multiple myeloma . Blood 2005 ; 106 : 359 .

    Google Scholar 

  24. Richardson PG, Sonneveld P, Schuster MW, Irwin D, Stadtmauer E, Facon T et al . Bortezomib or high-dose dexamethasone for relapsed multiple myeloma . N Engl J Med 2005 ; 352 : 2487 – 2498 .

    Article  CAS  Google Scholar 

  25. Rajkumar SV, Dispenzieri A . Evaluation and monitoring of response to therapy in multiple myeloma . Haematologica 2005 ; 90 : 1305 – 1308 .

    PubMed  Google Scholar 

  26. Barlogie B, Kyle RA, Anderson KC, Greipp PR, Lazarus HM, Hurd DD et al . Standard chemotherapy compared with high dose chemoradiotherapy for multiple myeloma: final results of phase III US Intergroup trial S9321 . J Clin Oncol 2006 ; 24 : 929 – 936 .

    Article  CAS  Google Scholar 

  27. Barlogie B, Tricot G, Anaissie E, Shaughnessy J, Rasmussen E, van Rhee F et al . Thalidomide and hematopoietic-cell transplantation for multiple myeloma . N Engl J Med 2006 ; 354 : 1021 – 1030 .

    Article  CAS  Google Scholar 

  28. Palumbo A, Bringhen S, Caravita T, Merla E, Capparella V, Callea V et al . Oral melphalan and prednisone therapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: a randomized controlled trial . Lancet 2006 ; 367 : 825 – 831 .

    Article  CAS  Google Scholar 

  29. Alexanian R, Weber D, Giralt S, Dimopoulos M, Delasalle K, Smith T et al . Impact of complete remission with intensive therapy in patients with responsive multiple myeloma . Bone Marrow Transplant 2001 ; 27 : 1037 – 1043 .

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Consortia

Corresponding authors

Correspondence to B G M Durie or S V Rajkumar.

Additional information

Please see Corrigendum. The PDF and HTML versions of this article remain uncorrected.

Please click on the abstract or full text for the link to the corrigendum attached to this article. Please note the article and PDF have not been corrected.

Appendix A.

Appendix A.

International myeloma working group:

Raymond Alexanian, MD Anderson, Houston, Texas

Kenneth Anderson, DFCI, Boston, Massachusetts

Michael Attal, Purpan Hospital, Toulouse, France

Herve Avet-Loiseau, Institute de Biologie, Nantes, France

Leif Bergsagel, Mayo Clinic Scottsdale

Joan Bladé, Hospital Clinica, Barcelona, Spain

Bart Barlogie, MIRT UAMS Little Rock, Arkanas

Regis Batille, Nantes, France

Meral Beksac, Ankara University, Turkey

Andrew Belch, Cross Cancer Institute, Canada

Mario Boccadoro, University of Torino

Michele Cavo, Bologna, Italy

Tony Child, United Kingdom

Ray Comenzo, Memorial-Sloan Kettering Cancer Center, New York

John Crowley, Cancer Research and Biostatistics, Seattle, Washington

William Dalton, H Lee Moffitt, Tampa, Florida

Faith Davies, Royal Marsden Hospital, London, England

Meletios Dimopoulos, Alexandra Hospital, Athens, Greece

Angela Dispenzieri, Mayo Clinic, Rochester, Minnesota

Brian Durie, Cedars-Sinai Outpatient Medical Center, Los Angeles, California

Theirry Facon, Centre Hospitalier Regional Universitaire de Lille, France

Dorotea Fantl, Buenos Aires, Argentina

Jean-Paul Fermand, Paris, France

Rafael Fonseca, Mayo Clinic Scottsdale, Scottsdale, Arizona

Gosta Gahrton, Karolinska Institutet, Stockholm , Sweden

Morie Gertz, Mayo Clinic

Hartmut Goldschmidt, Heidelberg, Germany

Philip Greipp, Mayo Clinic

Roman Hajek, Brno University, Brno, Czech Republic

Jean-Luc Harousseau, Institute de Biologie, Nantes, France

Kim Hawkins, Statistician, United Kingdom

Martin Hjorth, Data manager, Netherlands

Vania Hungria, Clinica San Germano, Sao Paolo, Brazil

Mohamad Hussein, The Cleveland Clinic, Cleveland, Ohio, USA

Peter Jacobs, South Africa

Mariana Juni, Fundaleu, Buenos Aires, Argentina

Douglas Joshua, Royal Prince Alfred Hospital, Sydney, Australia

Michael Katz, New York

Michio Kawano, Yamaguchi University, Ube, Japan

Shaji Kumar, Mayo Clinic

Robert Kyle, Mayo Clinic

Juan Lahuerta, Madrid, Spain

Henk Lokhorst, University Hospital, Utrecht, The Netherlands

Heinz Ludwig, Wilhelminenspital Der Stat Wien, Vienna

Jayesh Mehta, Northwestern University, Chicago

Giampaolo Merlini, University of Pavia, Pavia, Italy

Philippe Moreau, Nantes, France

Gareth Morgan, Royal Marsden Hospital, London

Antonio Palumbo, Cathedra Ematologia, Torino, Italy

Santiago Pavlovsky, Fundaleu, Buenos Aires, Argentina

Amara Nouel, Bolivar, Venezuela

Susie Novis, IMF, Los Angeles, California

Raymond Powles, Leukaemia & Myeloma, Wimbledon

Linda Pilarski, The University of Alberta, Edmonton Alberta, Canada

S Vincent Rajkumar, Mayo Clinic

Tony Reiman, Cross Cancer Institute, Canada

Paul Richardson, Dana Farber Cancer Institute, Boston, Massachusetts

Angelina Rodriquez Morales, Bonco MetroPolitano de Sangre, Caracas, Venezuela

Kazuyuki Shimizu, Nagoya City Midori General Hospital, Nagoya, Japan

David Siegel, Hackensack, Cancer Center, Hackensack, New Jersey

Guido Tricot, MIRT UAMS, Little Rock, Arkansas

Jesus San Miguel, University of Salamanca

Seema Singhal, Northwestern University

Pieter Sonneveld, Erasmus University Hospital, Rotterdam, The Netherlands

Keith Stewart, Mayo Clinic Scottsdale

Patrizia Tosi, Bologna, Italy

Ingemar Turesson, Malmo, Sweden

Ivan Van Riet, Brussels Vrija University

David Vesole, St Vincent's Comprehensive Cancer Center, New York

Donna Weber, MD Anderson, Houston, Texas

Jan Westin, University of Gothenberg, Sweden

Keith Wheatley, University of Birmingham, Edgbaston, Birmingham, UK

Brian Van Ness, University of Minnesota

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Durie, B., Harousseau, JL., Miguel, J. et al. International uniform response criteria for multiple myeloma. Leukemia 20, 1467–1473 (2006). https://doi.org/10.1038/sj.leu.2404284

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.leu.2404284

Keywords

  • myeloma
  • response criteria
  • staging
  • survival duration
  • uniform criteria
  • clinical outcomes

This article is cited by

Search

Quick links