# Episode 71. Management of Newly Diagnosed Multiple Myeloma with Dr. Vincent Rajkumar

Page: https://stenobird.com/podcast/blood-cancer-talks-5570002/episode-71-management-of-newly-diagnosed-multiple-myeloma-with-dr-vincent-rajkumar
Text version: https://stenobird.com/podcast/blood-cancer-talks-5570002/episode-71-management-of-newly-diagnosed-multiple-myeloma-with-dr-vincent-rajkumar.md
Podcast: [Blood Cancer Talks](https://stenobird.com/podcast/blood-cancer-talks-5570002)
Published: 2026-05-19T16:27:37+00:00
Episode link: https://share.transistor.fm/s/85832ee7
Audio file: https://media.transistor.fm/85832ee7/a2c35676.mp3
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JSON: https://stenobird.com/v1/public/podcasts/blood-cancer-talks-5570002/episodes/episode-71-management-of-newly-diagnosed-multiple-myeloma-with-dr-vincent-rajkumar
Duration seconds: 3126

## Resource

In this episode, Raj, Ashwin, and Eddie sit down with Dr. Vincent Rajkumar — Professor of Medicine at Mayo Clinic and Chair of the ECOG Myeloma Committee — for a clinically focused conversation on newly diagnosed multiple myeloma. Topics span baseline workup, risk stratification, induction selection, transplant timing, MRD-directed decision-making, and maintenance strategy. The episode closes with a discussion of Open Medicine, a new medical education platform, and Dr. Rajkumar's ongoing advocacy on drug pricing reform. KEY TOPICS DISCUSSED Baseline workup: 24-hour urine protein: It is important to obtain 24-hour urine protein with electrophoresis and immunofixation in all newly diagnosed patients — not for diagnosis, but to establish a baseline for long-term management and to distinguish M-protein from albuminuria. In patients where an FLC ratio ≥100 is the sole myeloma-defining criterion, a 24-hour urine Bence Jones protein ≥200 mg is part of the diagnostic threshold for treatment initiation. Myeloma cast nephropathy: when to biopsy: An involved FLC ≥50 mg/dL supports a presumptive diagnosis of cast nephropathy and treatment can begin without a kidney biopsy. Below this threshold — particularly if renal involvement is the sole myeloma-defining event — kidney biopsy is warranted to exclude light chain deposition disease, MPGN, or other unrelated disorders. It warrants aggressive early treatment (Dara-VCD or Dara-VD), starting even before bone marrow results are available when the diagnosis is clinically clear. Solitary plasmacytoma [with or without minimal bone marrow involvement]: Patients with ~10% clonal plasma cells technically meet criteria for myeloma, but management in this borderline zone warrants shared decision-making. Solitary plasmacytoma as sitting betwee…

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## Transcript

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