Multiple myeloma classification: Difference between revisions

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Revision as of 04:52, 18 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 can 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, as follows:


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 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

Multiple myeloma can be classified according to risk status. The risk stratification for multiple myeloma consists of three groups, as follows:


Risk group	Chromosomal Abnormalities	Frequency

Standard risk	t(11;14) t(6;14) Trisomies	75%
Intermediate Risk	t(4;14) Gain(1q)	10%
High risk	t(14;16) t(14;20) del(17p)	15%\|-

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 4: / Line 4: @@
 ==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).<ref name="pmid10357398">{{cite journal| author=Alexiou C, Kau RJ, Dietzfelbinger H, Kremer M, Spiess JC, Schratzenstaller B et al.| title=Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts. | journal=Cancer | year= 1999 | volume= 85 | issue= 11 | pages= 2305-14 | pmid=10357398 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10357398  }}</ref>
+Multiple myeloma can 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).<ref name="pmid10357398">{{cite journal| author=Alexiou C, Kau RJ, Dietzfelbinger H, Kremer M, Spiess JC, Schratzenstaller B et al.| title=Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts. | journal=Cancer | year= 1999 | volume= 85 | issue= 11 | pages= 2305-14 | pmid=10357398 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10357398  }}</ref>
 ==Classification==
-Plasma cell disorders such as multiple myeloma and its related diseases are classified according to disease burden and the extent of organ involvement.
+Plasma cell disorders such as multiple myeloma and its related diseases are classified according to disease burden and the extent of organ involvement, as follows:
@@ Line 63: / Line 63: @@
 *Post-transplant lenalidomide maintenance
 (''Please see Therapy section for details''
+|-
+|}
+Multiple myeloma can be classified according to risk status. The risk stratification for multiple myeloma consists of three groups, as follows:
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+|valign=top|
+|+
+! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Risk group}}
+! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Chromosomal Abnormalities}}
+! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Frequency}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
+Standard risk
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*t(11;14)
+*t(6;14)
+*Trisomies
+| style="padding: 5px 5px; background: #F5F5F5;" |
+%
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+Intermediate Risk
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*t(4;14)
+*Gain(1q)
+| style="padding: 5px 5px; background: #F5F5F5;" |
+%
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+High risk
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*t(14;16)
+*t(14;20)
+*del(17p)
+| style="padding: 5px 5px; background: #F5F5F5;" |
+%|-
 |-
 |}

Multiple myeloma classification: Difference between revisions

Revision as of 04:52, 18 July 2018

Overview

Classification

References

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