Multiple Myeloma Response Criteria (IMWG 2016)
International Myeloma Working Group (IMWG) 2016 response criteria for multiple myeloma. Used to assess depth of response to therapy. Guides treatment decisions: continuation, maintenance, or intensification. Includes stringent complete response (sCR), complete response (CR), very good partial response (VGPR), partial response (PR), minimal response (MR), stable disease (SD), and progressive disease (PD).
Score interpretation
Deepest response category -- sCR achieved
→ Continue current therapy or transition to maintenance (lenalidomide single agent per NICE TA587); response confirmed on two consecutive assessments at least 6 weeks apart; consider MRD (minimal residual disease) testing by NGS or NGF for prognostic information; discuss consolidation and maintenance plan with MDT; monitor monthly FLC, SPEP/IFE, urine Bence Jones protein; coordinate follow-up with haematology specialist nurse; advise patient of response and discuss PFS implications.
CR achieved -- excellent response to myeloma therapy
→ Continue therapy to deepen response towards sCR if possible; confirm on two consecutive assessments; consider bone marrow biopsy for MRD testing; lenalidomide maintenance recommended post-ASCT (NICE TA587); monitor SPEP, IFE, FLC monthly; if proceeding to autologous stem cell transplant (ASCT), discuss timing with transplant centre; discuss prognosis and treatment goals with patient.
VGPR -- significant response to therapy
→ Aim to deepen response to CR/sCR if possible; assess eligibility for ASCT if not yet done; consider bortezomib-based consolidation post-ASCT; monthly monitoring: SPEP, IFE, FLC, urine Bence Jones protein; imaging (PET-CT or whole body MRI) if clinically indicated; discuss response with patient and set expectations for further treatment.
PR -- partial response achieved; assess for deeper response opportunity
→ Continue current induction therapy and reassess at each cycle; if plateau reached, consider switch or intensification; assess ASCT eligibility for newly diagnosed patients; ensure bisphosphonate therapy ongoing (zoledronic acid monthly); VTE prophylaxis if on IMiD (aspirin, LMWH, or DOACs per IMPEDE-VTE/IMWG guidelines); bone marrow trephine if response assessment is unclear; renal function monitoring with proteasome inhibitor or IMiD therapy.
MR -- suboptimal response; consider regimen change
→ Discuss with MDT: may need regimen switch or intensification; check compliance and tolerability; assess for early progression; if newly diagnosed, optimise induction before transplant; consider salvage therapy options (daratumumab-based, carfilzomib-based, or clinical trial); ensure supportive care: bone protection, infection prophylaxis (aciclovir, co-trimoxazole or alternative); haematology specialist nurse review for patient support.
SD -- no response but no progression; monitor closely
→ Continue current therapy if tolerated and no toxicity; monitor every 4-8 weeks; if stable for 6 months or more consider consolidation or maintenance if not yet given; watch for early progression signs (rising M-protein, new symptoms, rising calcium, worsening renal function, new bone lesions); ensure adequate supportive care; discuss with patient.
PD -- confirmed disease progression; salvage therapy required
→ Urgent MDT discussion for salvage therapy; consider: daratumumab-based combination (NICE TA573/TA645), carfilzomib/lenalidomide/dexamethasone (KRd, NICE TA457), pomalidomide/dexamethasone (NICE TA427), isatuximab combinations; assess for clinical trial eligibility (especially if third-line or beyond); ensure updated MGUS/myeloma imaging (PET-CT or whole body MRI); manage myeloma complications: fractures (orthopaedic and radiotherapy referral), renal impairment (nephrology), hypercalcaemia (IV fluids, bisphosphonates, steroids); early palliative care involvement if multiple lines of therapy exhausted; update patient and family on prognosis.
Interpretation bands for the Myeloma Response. Apply clinical judgement and local guidance.
References
- Kumar S et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016;17(8):e328-e346.
- NICE TA587. Lenalidomide for maintenance treatment of multiple myeloma following an autologous stem cell transplant. NICE. 2019.
Related
Curated clinical cross-links plus same-class fallbacks.
- Dairy products · Nutritional source (calcium, protein, vitamin D)
- Bortezomib · Proteasome Inhibitor — Myeloma
- Thalidomide · Immunomodulatory Drug (IMiD) — Myeloma
- Daratumumab · Anti-CD38 Monoclonal Antibody — Myeloma
- Protein C (Specialist drug) · Recombinant/plasma-derived protein C concentrate
- Respiratory syncytial virus (RSV) vaccine · RSV pre-fusion F protein vaccine
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.