Should I wait for the development of CRAB prior to initiating therapy in multiple myeloma patients?

FAQ Library published on October 11, 2016
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Sergio Giralt, MD
Professor of Medicine
Weill Cornell Medical College
Chief Attending Physician
Adult Bone Marrow Transplant Service
Memorial Sloan-Kettering Cancer Center
New York, New York

Welcome to Managing Myeloma. My name is Sergio Giralt, and I am the Melvin Berlin Family Chair in Myeloma Research at Memorial Sloan Kettering Cancer Center. I am also a Professor of Medicine at Weill Cornell Medical College, and the Chief of the Adult BMT Service at Memorial Hospital in New York City.

I am frequently asked whether or not one should wait for the development of CRAB criteria, prior to initiation of therapy in multiple myeloma patients. The quick answer is no. Newly developed criteria by the IMWG have now established that patients with bone marrow plasma cells of more than 60% (≥60%), patients with severe abnormalities in their free light chains (sFLC involved:uninvolved ratio ≥100), or patients with abnormal MRIs (>1 lesions ≥5 mm), are at such high risk of developing CRAB criteria, that they should be considered for early therapy before these abnormalities develop. Early treatment is essential to prevent these early abnormalities, and will probably translate into better quality of life for the patients in which we have not allowed the disease to develop severe anemia, develop bone lesions, and develop renal dysfunction, or calcium abnormalities.

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Please view the Updated Criteria for the Diagnosis of Multiple Myeloma.

Last modified: September 22, 2016