The Unknown Patient has met many fellow patients who have been diagnosed with MGUS (Monoclonal Gammopathy of Undetermined Significance) or smoldering myeloma. These folks are always curious to learn what they can do to help prevent or delay the progression of the disease to active myeloma that requires treatment. This was the focus of this very interesting and very well attended session.
The session, chaired by Drs. Robert Kyle and Brian Durie, covered diagnostic criteria and prognostic factors important for MGUS and indoloent/smoldering myeloma.
Criteria For The Classification Of Monoclonal Gammopathies, Multiple Myeloma And Related Disorders: A Report Of The International Myeloma Working Group
Dr. Kyle presented results from the International Myeloma Working Group. New criteria have been developed for MGUS, smoldering or asymptomatic myeloma and symptomatic or active myeloma. The important point is that active myeloma implies a need for therapy and requires presence of "myeloma-related organ dysfunction." For some Unknown reason, the scientific community seems constantly in search of new acronyms and, in that spirit, have added "CRAB" to the already overwhelming list. "CRAB" stands for Calcium elevation, Renal dysfunction, Anemia, Bone disease. The working group's diagnostic criteria and patient management guidelines will be published shortly (British Journal of Haematology and The Hematology Journal, respectively.)
The Unknown patient applauds this effort to bring some clarity and consensus to what is all too often a confusing landscape.
Risk Factors For Early Progression Of Asymptomatic Multiple Myeloma: Dr. Donna Weber
Dr. Weber reviewed various risk factors for early progression. She identified high protein levels and abnormal MRI patterns as the most significant indicators of risk
Cytogenic Changes In The Evolution Of MGUS To Multiple Myeloma: Dr. Thierry Façon
Dr. Façon focused on the risks presented by abnormal cytogentics, noting that those with chromosomal abnormalities appear to be more at risk for progression. He noted that progress in genetic analysis with micro-arrays (chips) will likely improve our understanding of the specific molecular changes that occur with progression.
Circulating Plasma Cells, Labeling Index And Angiogenesis In MGUS and Smoldering Multiple Myeloma: Dr. Vincent Rajkumar
Dr. Rajkumar pointed to three factors that appear to correlate with progression to active disease. These included circulating plasma cells, an increase in labeling index (which measures the proportion of the plasma cells that are actively reproducing) and increasing angiogeniesis (blood vessel formation) in the bone marrow. Other factors included high protein levels and high levels of plasma cells in the bone marrow, as well as having a non-IgG monoclonal protein.
Cytokines In MGUS: Therapeutic Interventions To Prevent Progression: Dr. John Lust
Dr. Lust discussed the role of cytokines in progression . He pointed out that there is a correlation of higher levels of the cytokine IL-1b and bone disease.
MGUS: Clinical Predictors Of Malignant Transformation in 434 Patients From A Single Institution With Long Floow-Up: Dr. S. Montoto
Dr. Montoto's research indicates that higher m-compnent levels (>3.5 g/dl) and IgA and/or kappa sub-types are associated with transformation to active myeloma.
The panel (below) fielded questions at the end of the session.
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Please note that the Unknown Patient is a patient, not a doctor and not a scientist. This summary represents a layman's view of what was said at the conference and should form a basis for raising awareness of issues that could be discussed with a qualified professional. In no way should anything contained in this report be taken as medical advice or form the basis for action without first consulting a qualified medical professional who is familiar with your specific medical situation.