Multiple myeloma classification

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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).

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 Surgery if there is a need for spine stabilization, fixation of fracture, or decompressive laminectomy Adjuvant chemotherapy is some cases, though not consistently recommended
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 Chemotherapy with lenalidomide and dexamethasone for high-risk patients
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

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