Multiple myeloma classification: Difference between revisions

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Revision as of 04:43, 15 July 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2] Shyam Patel [3]

Overview

Multiple myeloma may be classified into several subtypes based on the extent of organ involvement (medullary or extramedullary) and the disease clinical presentation(active symptomatic or smoldering asymptomatic).^[1]

Classification

Plasma cell disorders such as multiple myeloma and its related diseases are classified according to disease burden and the extent of organ involvement.


Disease	Diagnostic Criteria	Management Approach

Solitary bone plasmacytoma or extraosseous plasmacytoma	Biopsy of solid mass with histology and immunohistochemistry consistent with clonal plasma cells as a homogenous infiltrate plus Absence of clonal plasma cells in bone marrow plus Absence of end-organ damage such as anemia, hypercalcemia, renal dysfunction, or osseous lesions	Localized fractionated radiation therapy of 40-50 Gy over 4 weeks^[2] Surgery if there is a need for spine stabilization, fixation of fracture, or decompressive laminectomy^[2] Adjuvant chemotherapy is some cases, though not consistently recommended^[2]
Monoclonal gammopathy of undetermined significance	Presence of M-spike that quantitates < 3 g/dl on protein electrophoresis, or Presence of bone marrow plasma cell burden of < 10% plus Absence of end-organ damage such as anemia, hypercalcemia, renal dysfunction, or osseous lesions	Monitoring of complete blood count every 6-12 months
Smoldering multiple myeloma	Presence of M-spike that quantitates > 3 g/dl on protein electrophoresis, or Presence of bone marrow plasma cell burden of > 10% but < 60% plus Absence of end-organ damage such as anemia, hypercalcemia, renal dysfunction, or osseous lesions	Monitoring of complete blood count at specified intervals, depending on risk stratification
Active multiple myeloma	Presence of M-spike that quantitates > 3 g/dl on protein electrophoresis, or Presence of bone marrow plasma cell burden of > 10% but < 60% plus Presence of at least one of the following: anemia, hypercalcemia, renal dysfunction, osseous lesions, bone marrow plasma cell burden > 60%, serum free light chain ratio (of involved to uninvolved light chain) > 100, MRI showing > 1 bony lesion of at least 5mm	Induction chemotherapy with bortezomib, lenalidomide, and dexamethasone High-dose therapy plus autologous stem cell transplantation Post-transplant lenalidomide maintenance (Please see Therapy section for details

References

↑ Alexiou C, Kau RJ, Dietzfelbinger H, Kremer M, Spiess JC, Schratzenstaller B; et al. (1999). "Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts". Cancer. 85 (11): 2305–14. PMID 10357398.
↑ ^2.0 ^2.1 ^2.2 Caers J, Paiva B, Zamagni E, Leleu X, Bladé J, Kristinsson SY; et al. (2018). "Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel". J Hematol Oncol. 11 (1): 10. doi:10.1186/s13045-017-0549-1. PMC 5771205. PMID 29338789.

Template:WikiDoc Sources

[pmid10357398-1] Alexiou C, Kau RJ, Dietzfelbinger H, Kremer M, Spiess JC, Schratzenstaller B; et al. (1999). "Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts". Cancer. 85 (11): 2305–14. PMID 10357398.

[pmid29338789-2] 2.0 ^2.1 ^2.2 Caers J, Paiva B, Zamagni E, Leleu X, Bladé J, Kristinsson SY; et al. (2018). "Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel". J Hematol Oncol. 11 (1): 10. doi:10.1186/s13045-017-0549-1. PMC 5771205. PMID 29338789.

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Multiple myeloma}}
-{{CMG}} {{AE}}{{HL}}
+{{CMG}} {{AE}}{{HL}} {{shyam}}
 ==Overview==
@@ Line 18: / Line 18: @@
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
-[[Solitary plasmacytoma]]
+[[Solitary bone plasmacytoma or extraosseous plasmacytoma]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-Biopsy of solid mass showing clonal plasma cells
+*Biopsy of solid mass with histology and immunohistochemistry consistent with clonal plasma cells as a homogenous infiltrate
+''plus''
+*Absence of clonal plasma cells in bone marrow
+''plus''
+*Absence of end-organ damage such as anemia, hypercalcemia, renal dysfunction, or osseous lesions
 | style="padding: 5px 5px; background: #F5F5F5;" |
-Radiation therapy
+*Localized fractionated radiation therapy of 40-50 Gy over 4 weeks<ref name="pmid29338789">{{cite journal| author=Caers J, Paiva B, Zamagni E, Leleu X, Bladé J, Kristinsson SY et al.| title=Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel. | journal=J Hematol Oncol | year= 2018 | volume= 11 | issue= 1 | pages= 10 | pmid=29338789 | doi=10.1186/s13045-017-0549-1 | pmc=5771205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29338789  }} </ref>
+*Surgery if there is a need for spine stabilization, fixation of fracture, or decompressive laminectomy<ref name="pmid29338789">{{cite journal| author=Caers J, Paiva B, Zamagni E, Leleu X, Bladé J, Kristinsson SY et al.| title=Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel. | journal=J Hematol Oncol | year= 2018 | volume= 11 | issue= 1 | pages= 10 | pmid=29338789 | doi=10.1186/s13045-017-0549-1 | pmc=5771205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29338789  }} </ref>
+*Adjuvant chemotherapy is some cases, though not consistently recommended<ref name="pmid29338789">{{cite journal| author=Caers J, Paiva B, Zamagni E, Leleu X, Bladé J, Kristinsson SY et al.| title=Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel. | journal=J Hematol Oncol | year= 2018 | volume= 11 | issue= 1 | pages= 10 | pmid=29338789 | doi=10.1186/s13045-017-0549-1 | pmc=5771205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29338789  }} </ref>
 |-
 | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |

Multiple myeloma classification: Difference between revisions

Revision as of 04:43, 15 July 2018

Overview

Classification

References

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