Guidelines for the diagnosis and management of multiple. The contents of diagnosis and management of multiple myeloma are listed below. Myeloma is a type of cancer that develops from plasma cells in the bone marrow. Multiple myeloma is a cancer of the bone marrow plasma cells.
It has to be distinguished from a igm secreting lymphoid mgus, a precursor phase of chronic. Virtually every case of mm is preceded by a premalignant pc tumor called monoclonal gammopathy of undetermined significance mgus 6, 7 that, like mm, produces a typical mspike almost always nonigm by spep or free light chain in the urine. An approach to the diagnosis and management of multiple myeloma. Myeloma is usually called multiple myeloma because most people 90% or more have multiple bone lesions when diagnosed or lesions develop over the course of the illness. Criteria for the classification monoclonal gammopathies, multiple myeloma and related disorders. Multiple myeloma is a form of cancer that begins in plasma cells and affects multiple bones. Multiple myeloma is a cancer of certain cells of the bone marrow called plasma cells. Multiple myeloma objectives and mgus of hematopoietic. Hyperdiploid myeloma is characterized by multiple trisomies of chromosomes 3, 5, 7, 9 11, 15, 19 and 21, and lacks recurrent immunoglobulin gene translocations. This is a comprehensive, state of theart guide to the diagnosis, treatment, and biology of multiple myeloma and related plasma disorders. Multiple myeloma dr harpreet singh bhatia dmch, ludhiana,punjab 2. Mm is characterized by several cytogenetic abnormalities that occur at various time points in. Management of multiple myeloma dr saqib ahmad shah pg department of radiation oncology skims moderator. The initial treatment for multiple myeloma may be either.
Multiple myeloma mm is a neoplastic plasma cell disorder characterized by clonal proliferation of malignant plasma cells in the bone marrow and usually monoclonal protein in the blood andor urine. Multiple myeloma and common symptoms about 10% to 20% of patients with newly diagnosed myeloma will not have any symptoms. Multiple myeloma mm is an aggressive malignant neoplasm of plasma cells that accumulates in the bone marrow and contributes to approximately 15 percent of all hematologic malignancies. The interpretation of cytogenetic abnormalities in multiple myeloma mm is often a challenging task. First described in 1848, mm is characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein m protein. In the united states, the lifetime risk of getting multiple myeloma is 1 in 2 0. Mm is characterized by several cytogenetic abnormalities that. As bone marrow is found in multiple areas of the body e. Multiple myeloma mm, also known as symptomatic plasma cell myeloma, is a plasma cell malignancy. Edited and written by a multidisciplinary group of recognized authorities from the mayo clinic, it presents clear guidelines on diagnosis and therapy and covers all aspects of multiple myeloma, from. Multiple myeloma features abnormal proliferation of plasma cells in the bone marrow, destructive bone lesions, and the production of abnormal proteins, specifically antibodies. Multiple myeloma is a cancer of plasma cells that produce monoclonal immunoglobulin and invade and destroy adjacent bone tissue. The disease is called multiple myeloma because it affects many bones.
Multiple myeloma is a type of cancer that targets the plasma cells in bone marrow. Leukemia 2006 w erratum 2007 mprotein in serum andor urine or abnormal flc ratio. Plain films revealed a lytic lesion in his left proximal femur as well as additional smaller lytic lesions. A single mass of myeloma cells is called a solitary plasmacytoma, which is most often found in the bones but can also be found in soft tissue called an extramedullary plasmacytoma. Plasma cells come from b lymphocytes, and produce antibodies immunoglobulins. Multiple myeloma mm is a disease that is primarily treated by hematologists. Multiple myeloma objectives and mgus of hematopoietic stem. Current status relapsed disease transient response to therapy survival years diagnosis survival 35 yrs survival multiple myeloma is an evolving disease state, and amgen plans several substantive updates to the content of this site in the coming months. The management of multiple myeloma from the hematology laboratory rufts, boston city hospital, boston, massachusetts william c.
This patientspecific mprotein can be detected in the serum or in the urine as free light chains. Solitary plasmacytoma is a mass of myeloma cells that involves only 1 site in the bone or, less commonly, other organs, such as in the upper respiratory tract, including the. Myeloma can cause a range of symptoms because of its effect on the bones, bone marrow, blood, urine and kidneys. Why myeloma patients need exercise register for muscles for myeloma by danny parker you need to exercise. It presents most frequently as bone pain and patients tend to become dehydrated and may develop renal failure. The first of these drugs to be developed, thalidomide, caused severe birth defects when taken during pregnancy.
Bone disease and renal failure are the main cause of morbidity. Pdf on nov 29, 2005, alastair smith and others published guidelines on the diagnosis and management of multiple myeloma 2005 find. The dna of plasma cells becomes damaged and this causes the cells to become cancerous. These patients typically fulfill the diagnostic criteria for multiple myeloma and have evidence of amyloid light chain deposition confirmed by congo red staining. Plasma cells make antibodies against infectious agents such as viruses and bacteria. A cancerous or malignant plasma cell is called a myeloma cell.
Imwg publishes recommendations for the diagnosis and management of myelomarelated renal impairment. Epidemiology 2000 new canadian patient with myeloma in 2007 207 new patients in bc in 2005 169 patients died of myeloma in 2004 500 patients with myeloma in bc. The changing paradigm highdose chemotherapy and stem cell transplantation todd zimmerman, md university of chicago medical center. Multiple myeloma is the most common type of plasma cell tumor. Management of multiple myeloma in the newly diagnosed patient. Management of multiple myeloma linkedin slideshare.
Multiple myeloma mm is characterized by the neoplastic proliferation of clonal plasma cells producing a monoclonal immunoglobulin. Please subscribe to be notified as these updates become available. Myeloma associated al amyloidosis is reported in 1230% of multiple myeloma patients. Three immunomodulating agents are used to treat multiple myeloma. Not only do you need to listen carefully to your doctors, take the required drugs, go through the required treatments and eat well you knew i will tell you that, but you need to exercise too. Treatment of multiple myeloma focuses on decreasing the severity of symptoms with medications, stem cell transplants, bisphosphonate therapy, platelet transfusions. Multiple myeloma is divided into two distinct genetic subtypes based on chromosome content. Pdf guidelines on the diagnosis and management of multiple. This is a comprehensive, stateoftheart guide to the diagnosis, treatment, and biology of multiple myeloma and related plasma disorders. This emedtv article describes this condition in detail and includes information about its symptoms, diagnosis, and treatment. Pdf multiple myeloma mm is a plasma cell dyscrasia that accounts for 10% of haematological malignancies.
P director of the h ematology laboratory tufts, boston city hospital. When multiple myeloma is suspected clinically, patients should be tested for the presence of m proteins using a combination of tests that should include a serum protein electrophoresis spep, serum immunofixation, and the serum flc assay. Common manifestations include lytic lesions in bones causing pain, andor fractures, renal insufficiency, hypercalcemia, anemia, and recurrent infections. Interpretation of cytogenetic results in multiple myeloma. However, different people with myeloma can have different symptoms, and most will only have one or two symptoms. Why myeloma patients need exercise the myeloma crowd. Multiple myeloma mm belongs to the group of plasma cell neoplasms table 1. Multiple myeloma occurs in over 2000 new patients in england and wales each year. Multiple myeloma is a malignant plasma cell disorder in the bone marrow, which produce a monoclonal immunoglobulin paraprotein or mprotein. Click plasmacytoma for more information about this type of plasma cell tumor.
Median survival is about three years, but some patients have a life expectancy of 10 years. Cancer society, the total new cases of multiple myeloma diagnosed annually in canada are estimated at 2,550 1,450 men and 1,100 women, representing an incidence of 5 in 100,000 people. His research interests are in multiple myeloma and the bone marrow microenvironment as a potential therapeutic target. Watch the full interview with multiple myeloma patient ginny johnston in 2016, the american cancer society estimates that 30,330 new multiple myeloma cases will be diagnosed and 12,650 cancer deaths due to multiple myeloma would occur. Both nonintensive and intensive treatments involve taking a combination of antimyeloma medicines. Some early cancers may have signs and symptoms that can be noticed, but that is not always the case. Multiple myeloma is an evolving disease state, and amgen plans several substantive updates to the content of this site in the coming months. Amyloidosis should be suspected in the presence of. Pdf an approach to the diagnosis and management of multiple.
The american cancer society s estimates for multiple myeloma in the united states for 2020 are. The imf s reach extends to more than 525,000 members in 140 countries worldwide. Multiple myeloma early detection, diagnosis, and staging. It aims to improve care for people with myeloma by promoting the most effective tests and treatments for myeloma and its complications. Oct 30, 2015 the interpretation of cytogenetic abnormalities in multiple myeloma mm is often a challenging task. The international myeloma foundation can provide further support for myeloma patients. Patients may present with nonspecific symptoms, such as nausea, vom iting, malaise, weakness, recurrent infections, or weight loss. Myeloma is a cancer of plasma cells that begins in the bone marrow.
Patients with multiple myeloma mm often deal with short and longterm side effects of the treatment and disease sequelae. Multiple myeloma is a plasma cell neoplasm that is characterized by a single clone of plasma cells producing a monoclonal protein mprotein. Edited and written by a multidisciplinary group of recognized authorities from the mayo clinic, it presents clear guidelines on diagnosis and therapy and covers all aspects of multiple myeloma, from molecular classification and diagnosis, to risk. Monitor for multiple myeloma symptoms and m protein serum and urine every six to 12 months in patients with monoclonal gammopathy of undetermined significance, and every three to four months in. Multiple myeloma early detection, diagnosis, and staging cancer. Malignanat b cell lymphoproliferative disorder of the marrow with plasma cell predominating. It is characterised by a clonal population of bone marrow plasma cells which secrete a monoclonal paraprotein or an immunoglobulin free light chain flc figure 1a, b.
In may 20, the international myeloma working group imwg released practice guidelines for the management of multiple myelomarelated. These clonal plasma cells proliferate in the bone marrow and often result in extensive skeletal destruction with osteolytic lesions, osteopenia, andor pathologic fractures. Multiple myeloma is a cancer of the plasma cells in the bone marrow seek medical care for unexplained pain, nausea, vomiting, weight loss, vision problems, or chronic tingling or numbness there is no cure for multiple myeloma. Reasons for inadequately managed symptoms are multifactorial e. Identification and quantitation of paraprotein or m. Multiple myeloma represents 2% of all new cancer diagnoses in the united.
The imwgs research on multiple myeloma studies its causes, how to stage the disease, and how to achieve remission. Abstract multiple myeloma accounts for approximately 10% of. The following are a few of the topics that the imwg covers. The novel therapiesthalidomide, bortezomib, and lenalidomidehave resulted in improved survival rates. It is synonymous with myeloma and plasma cell myeloma. This guideline covers the diagnosing and managing of myeloma including smouldering myeloma and primary plasma cell leukaemia in people aged 16 and over. Public health service national cancer institute fellow in iiematology, hematology. Patients with indolent relapse can be treated with 2drug or 3drug combinations. Multiple myeloma is slightly more common in men than in women and the median age at the time of diagnosis is about 65 years. Clinical professor of medicine, tufts university medical school. Multiple myeloma mm is a debilitating malignancy that is part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance mgus to plasma cell leukemia. Interpretation of cytogenetic results in multiple myeloma for.
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