The Fellow on Call: The Heme/Onc Podcast Episode 144: Myeloma Series, Pt. 5 - Myeloma Risk Stratification and Response Criteria (2026)
Jan 7, 2026
Dive into the complexities of myeloma risk stratification and response criteria! Explore how newly diagnosed patients are assessed and why those criteria are crucial for treatment decisions. Learn about the significance of minimal residual disease (MRD) testing and its evolving role in clinical practice. The hosts break down different response definitions, such as partial and complete responses, alongside genomic factors that contribute to high-risk situations. Tune in for in-depth insights and the latest research trends!
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Clinical Case That Led To Myeloma Diagnosis
- A 63-year-old woman had an IgG kappa M spike with anemia and abnormal free light chain ratio prompting further workup.
- Bone marrow showed 60% clonal plasma cells and PET-CT found lytic lesions, confirming symptomatic multiple myeloma despite being asymptomatic.
Combine Flow And IHC For Plasma Cell Counts
- Use both aspirate (flow cytometry) and core biopsy (IHC) when evaluating plasma cell percentage.
- Rely on CD138 IHC on the core to better enumerate plasma cells because flow can under-report due to poor plasma cell survival.
Enrich Samples And Order Prognostic Labs
- Always run CD138-enriched plasma-cell FISH to get accurate cytogenetics for myeloma.
- Also order LDH, beta-2 microglobulin, and albumin since they feed into ISS/revised-ISS prognostic staging.