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get the correct diagnosis

GET THE CORRECT DIAGNOSIS

Recent studies confirm the importance diagnosing myeloma as early as possible. Myeloma is a very individual disease—often slow-moving, sometimes much more aggressive. A skilled myeloma specialist will be able to determine the best approach in your individual situation. 

07.01.15

WHAT IS MYELOMA?

KNOW WHAT YOU’RE DEALING WITH: GET THE CORRECT DIAGNOSIS

FEATURES WHICH RAISE SUSPICION OF POSSIBLE MYELOMA

  • Symptoms
    • 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
  • Signs
    • 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
    • Anemia
    • 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
    • FOR MORE DETAILS SEE STEP 2: TESTS

Diagnostic Criteria

  1. Monoclonal plasma cells in the bone marrow > 10% and/or presence of a biopsy-proven plasmacytoma
  2. Monoclonal protein present in the serum and/or urine
  3. Myeloma-related organ dysfunction – one or more of the following:
  4. [C] Calcium elevation in the blood (serum calcium > 10.5 mg/l or upper limit of normal)
  5. [R] Renal insufficiency (serum creatinine > 2 mg/dl)
  6. [A] Anemia (hemoglobin < 10 g/dl or 2 g < normal)
  7. [B] Lytic bone lesions or osteoporosisc

If the CRAB criteria are absent, patients most likely have a precursor state (a “pre-myeloma”), which falls into one of three categories:

  • MGUS- monoclonal gammopathy of undetermined significance More>>
  • Smoldering myeloma (low risk) More>>
  • Smoldering myeloma (high risk) More>>
Table 1 - Multiple Myeloma Diagnostic Criteria: All Three Required

1. Monoclonal plasma cells in the bone marrow > 10% and/or presence of a biopsy-proven plasmacytoma
2. Monoclonal protein present in the serum and/or urinea
3. 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.

All tables from Myeloma Management Guideline: a consensus report from the Scientific Advisors of the International Myeloma Foundation published in The Hematology Journal (2003) 4, 379-398.

Types of Myeloma

  • IgG myeloma with κ or λ light chains
    • 65% of myeloma patients
    • Has usual features of myeloma      
  • IgA myeloma with κ or λ light chains
    • Next-most common type
    • Sometimes characterized by tumors outside the bone       
  • IgD, IgE, and IgM myeloma
    • Rare types
    • IgD can be accompanied by plasma-cell leukemia and can cause kidney damage
  • “Light chain” or “Bence Jones myeloma” (10% of myeloma patients)
    • Most likely to cause kidney damage, and/or lead to deposits of light chains in kidneys and/or on nerves or other organs.
  • “Non-secretory” myeloma (1%-2% of myeloma patients)

REFERENCES

©2015 International Myeloma Foundation

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