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Expert Opinions On Multiple Myeloma

Module 1


  1. Defining The Disease
  2. Initial Detection and Diagnosis
  3. Prognosis and Staging

Defining The Disease

What is Multiple Myeloma?

Dr. Robert Kyle: Multiple myeloma is a neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. This clone proliferates in the bone marrow and destroys the bone itself, which is manifested by osteopenia, osteolytic lesions, and pathologic fractures. Anemia, renal insufficiency, and hypercalcemia may also occur. Slide 1

Even if we are not talking about a "cure", do transplants improve survival? Click here to view video clip

Dr. Brian Durie:
One critical question is whether or not allogeneic transplant is more likely to be associated with this type of long term disease free survival vs. other types of therapy, and in my mind, this is the point which is controversial because for allogeneic transplant, the possibility of long term disease free survival has to be balanced against the up front morbidity and mortality. Is it worth accepting the up front risks of morbidity and potential mortality which can run as was indicated from 20% even as high as 50%? Is it worth accepting that up-front risk for a small percentage chance of long term benefit? [23:39] In my mind, at the current state of knowledge, it is not worth it because I think the chance of long term disease free survival is more patient related than treatment related. There are some patients who do do well long term. To what extent it is related to treatment is not clear.

Initial Detection and Diagnosis

What is MGUS? What is the difference between MGUS and Multiple Myeloma?

Monoclonal gammopathy of undetermined significance, MGUS, M-GUS, MUGAS, is characterized by the proliferation of a small clone of plasma cells. These patients are generally defined as having an M protein less than 3 grams/dl and if a bone marrow is done, that it contains fewer than 10% plasma cells. These patients have no anemia, hypercalcemia or renal insufficiency related to the M protein production. There are no bone lesions. Slide 2

Prognosis and Staging

What is Waldenstrom's macroglobulinemia?

Waldenstrom's macroglobulinemia is a malignant disease manifested by the proliferation of a clone of lymphocytes which produce a monoclonal IgM protein. The bone marrow has an increased number of lymphocytes and hepatosplenomegaly and lymphadenopathy may also occur. Anemia and constitutional symptoms are indications for treating Waldenstrom's macroglobulinemia. Slide 3

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