International Myeloma Working GroupEdit
The International Myeloma Working Group (IMWG) is a global alliance of clinicians, researchers, and patient advocates dedicated to improving the diagnosis, risk stratification, and treatment of myeloma. By pooling data and clinical experience from centers around the world, the IMWG publishes consensus statements, diagnostic criteria, and treatment guidelines that shape day-to-day practice in hospitals and clinics. The group also promotes collaboration on clinical trials and translational research aimed at extending survival and enhancing quality of life for patients with myeloma worldwide.
From a pragmatic health-policy perspective, the IMWG emphasizes evidence-based care, timely access to effective therapies, and the use of biomarkers and imaging to tailor therapy to the individual patient. Its guidelines inform how physicians stage disease, decide when to start treatment, and select regimens that balance efficacy with safety and cost. The work has a global footprint, with members from major centers in different regions and involvement with industry partners and patient advocates. The IMWG’s outputs serve not only clinicians but payers and policymakers who design coverage and resource allocation in diverse health systems. In addition, the group pays attention to disparities in access to high-cost therapies and to how best to implement high-quality care in settings with varying levels of resources. multiple myeloma clinical trials biomarkers imaging health disparities patient advocacy
History
The IMWG grew out of international collaboration among hematologists and researchers seeking to harmonize how myeloma is diagnosed, staged, and managed across different countries and health systems. Its formation reflected a broader push in late 20th and early 21st century medicine to move away from fragmented, center-specific terminology toward standardized language and endpoints that could support both routine care and comparative research. Over the years, the group has anchored its work in a combination of consensus-building and data-driven updates, drawing on experience from large centers as well as real-world practice. International myeloma working group myeloma consensus statements
Key milestones include the development and updates of diagnostic criteria and response assessment, incorporation of imaging and biomarkers into staging, and the formalization of response and progression frameworks that clinicians use to decide when to escalate therapy. The IMWG has also helped define myeloma-defining events and refined the criteria for when a patient truly meets the threshold for treatment, moving beyond older notions that focused only on organ damage. The evolution of their work has paralleled advances in targeted therapies and the growing recognition of minimal residual disease as a potential surrogate endpoint in research. CRAB criteria myeloma-defining events international staging system revised international staging system minimal residual disease
Activities
Diagnostic criteria and staging
A central component of the IMWG's work is the consistent use of diagnostic criteria that determine when a patient has myeloma and when therapy should begin. The criteria historically rely on a combination of clonal plasma cell burden and myeloma-defining events, which include progressive organ or tissue impairment. The group has integrated imaging findings, such as MRI and PET-CT results, with laboratory markers to improve accuracy and consistency across centers. These diagnostic standards are frequently cited in clinical practice and trial design, and they guide decisions about further testing, risk stratification, and treatment initiation. CRAB criteria myeloma-defining events bone marrow biopsy magnetic resonance imaging positron-emission tomography International Staging System Revised International Staging System
Treatment guidelines and care pathways
IMWG guidelines cover first-line therapy and treatment for relapse, emphasizing regimens that have demonstrated meaningful benefit in terms of survival and tolerability. For younger, transplant-eligible patients, the guidelines often support induction therapy followed by autologous stem cell transplantation, followed by maintenance to prolong remission. For patients who are not transplant-eligible, the recommendations typically include combinations of proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies, with adjustments based on comorbidities and patient preferences. The guidelines also address supportive care, management of adverse events, and considerations for special populations. They increasingly incorporate monoclonal antibodies and modern proteasome inhibitors as standard options where evidence supports their use. autologous stem cell transplantation bortezomib lenalidomide dexamethasone daratumumab carfilzomib pomalidomide monoclonal antibody clinical trial
Research, data sharing, and education
Beyond clinical guidelines, the IMWG maintains and promotes networks for research collaboration, registries for real-world data, and educational resources for clinicians and patients. By encouraging standardized reporting and shared endpoints, the group aims to accelerate the translation of scientific discoveries into practice. This activity includes involvement in trial design, harmonization of laboratory and imaging methodologies, and dissemination of evidence through journals and conferences. clinical trial real-world evidence bone marrow biopsy biomarkers imaging
Controversies and debates
Cost, access, and the value of expensive therapies: The IMWG’s work intersects with policy debates about how to balance rapid access to breakthrough treatments with the realities of health-system budgets. Supporters argue that maintaining a robust pipeline and using efficacious drugs improves survival; critics stress the need for value-based pricing and sustainable access, particularly in lower-resource settings. The result is a continuing discussion about how guidelines translate into affordable care across different markets. drug pricing health disparities
Minimal residual disease (MRD) as a clinical endpoint: MRD negativity has emerged as a promising predictor of long-term outcomes, and the IMWG has incorporated MRD concepts into discussions of response. However, there is debate about whether MRD should drive routine treatment decisions in all patient groups or remain a research endpoint until standardized testing and interpretation are universally available and validated. minimal residual disease clinical trial
Global applicability of guidelines: While IMWG guidelines strive for broad relevance, some observers contend that they reflect practices most feasible in high-resource settings. Advocates for tiered or context-specific guidelines argue for adaptations that acknowledge differences in infrastructure, access to diagnostics, and drug availability while preserving core standards for patient safety and outcomes. global health health systems
Regulation, innovation, and access: The balance between encouraging innovation (through patent protections and market incentives) and enabling affordable access remains a policy battlefield. Proponents of streamlined regulatory approvals and value-based pricing argue these measures speed up patient access to new therapies, while critics worry about costs and the long-term sustainability of research funding. drug regulation patents value-based pricing
Framing of policy debates: Some critiques of modern healthcare discourse contend that policy discussions can overemphasize social determinants or political messaging at the expense of focusing on measurable patient outcomes and clinical effectiveness. Proponents of the traditional, outcomes-focused approach argue that guidelines should prioritize science and real-world results, while still acknowledging equity concerns as a practical constraint on care delivery. health policy health equity