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

KEY FINDING

• Presence of monoclonal protein in the blood and/or urine (M-SPIKE)
• Detected on:
• SPEP: serum protein electrophoresis
• And/or
• UPEP: urine protein electrophoresis
• The M-SPIKE is produced by the cancerous myeloma cells present in the bone marrow.
• In general, the amount of M-SPIKE 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

1. 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.
2. If careful evaluation reveals no other obvious cause, then definitive direct diagnosis is required.
3. 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 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.

4. 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>>
  

5. Another entity is solitary plasmacytoma of bone. More>>

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.

REFERENCES

©2011 International Myeloma Foundation