KNOW WHAT YOU’RE DEALING WITH: GET THE CORRECT DIAGNOSIS
FEATURES WHICH RAISE SUSPICION OF POSSIBLE MYELOMA
- Persistent or worsening tiredness due to anemia or reduced kidney function
- Sudden pain due to a broken bone in the spine, ribs, or elsewhere
- Recurrent unexplained infections, such as pneumonia, sinus, or urinary infection
- Pain with movement and/or at night/rest
- Pain tenderness/swelling of bone areas
- Swelling, shortness of breath or evidence of heart or kidney failure
- Lab test findings
- Possible low white blood cells or blood platelets
- Increased blood calcium
- Increased blood creatinine and/or blood urea nitrogen (BUN)
- Increased protein level in the blood and/or urine
- Presence of monoclonal protein in the blood and/or urine (M-SPIKE)
- Detected on:
- The M-SPIKE and free light chains are produced by the cancerous myeloma cells present in the bone marrow.
- In general, the amount of M-SPIKE or free light chains reflects the amount of myeloma. However, in some cases, a small amount of protein is produced or occasionally none (non-secretory [1%])”
HOW TO ESTABLISH THE CORRECT DIAGNOSIS IF A MONOCLONAL PROTEIN (M-SPIKE) IS PRESENT
- Exclude some other acute or chronic medical condition causing production of a monoclonal protein. Many conditions associated with inflammation, autoimmune, and/or allergic reactions and even other types of cancer can be associated with monoclonal protein production in a “reactive” fashion.
- If careful evaluation reveals no other obvious cause, then definitive direct diagnosis is required.
- The presence of 1 or more “CRAB” features is needed to confirm the diagnosis of active (“symptomatic”) myeloma requiring systemic anti-myeloma therapy.
|Table 1 - Multiple Myeloma Diagnostic Criteria: All Three Required
||Monoclonal plasma cells in the bone marrow > 10% and/or presence of a biopsy-proven plasmacytoma
||Monoclonal protein present in the serum and/or urinea
||Myeloma-related organ dysfunction (1 or more)b
- [C] Calcium elevation in the blood (serum calcium > 10.5 mg/l or upper limit of normal)
- [R] Renal insufficiency (serum creatinine > 2 mg/dl)
- [A] Anemia (hemoglobin < 10 g/dl or 2 g < normal)
- [B] Lytic bone lesions or osteoporosisc
|*Note: These criteria identify Stage IB and Stages II and III A/B myeloma by Durie/Salmon stage. Stage IA becomes smoldering or indolent myeloma.
a If no monoclonal protein is detected (non-secretory disease), then > 30% monoclonal bone marrow plasma cells and/or a biopsy-proven plasmacytoma required.
b A variety of other types of end organ dusfunction can occationally occur and lead to a need for therapy. Such dysfunction is sufficient to support classification as myeloma if proven to be myeloma related.
c If a solitary (biopsy-proven plasmacytoma or osteoporosis alone (without fractures) are the sole defining criteria, then > 30% plasma cells are required in the bone marrow.
- If the CRAB criteria are absent, patients most likely have a precursor state (a “pre-myeloma”). There are 3 categories:
- MGUS- monoclonal gammopathy of undetermined significance More>>
- Smoldering myeloma (low risk) More>>
- Smoldering myeloma (high risk) More>>
- Another entity is solitary plasmacytoma of bone. More>>
ASH 2011 Presentations that address STEP 1
©2011 International Myeloma Foundation