Multiple myeloma classification

Multiple myeloma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Multiple Myeloma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
Echocardiograph and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Future or Investigational Therapies
Case Studies
Case #1
Multiple myeloma classification On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Multiple myeloma classification All Images X-rays Echo and Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Multiple myeloma classification
CDC on Multiple myeloma classification
Multiple myeloma classification in the news
Blogs on Multiple myeloma classification
Directions to Hospitals Treating Multiple myeloma
Risk calculators and risk factors for Multiple myeloma classification

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).

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 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

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) (CCND1;IgH) t(6;14) (CCND3;IgH) Trisomies (chromosomes 3, 5, 7, 9, 11, 15, 19, 21) Hyperdiploidy	75%
Intermediate Risk	t(4;14) (FGFR3;IgH) Gain(1q21)	10%
High risk	t(14;16) (IgH;MAF) t(14;20) (IgH;MAFB) del(17p) (p53 deletion) Non-hyperdiploidy	15%|-

References

Template:WikiDoc Sources