Multiple myeloma classification: Difference between revisions

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Revision as of 04:27, 15 July 2018

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

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 plasmacytoma	Biopsy of solid mass showing clonal plasma cells	Radiation therapy
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.

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.

[1]

@@ Line 7: / Line 7: @@
 ==Classification==
-*Multiple myeloma is classified according to the extent of organ involvement into two subgroups:<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>
+Plasma cell disorders such as multiple myeloma and its related diseases are classified according to disease burden and the extent of organ involvement.
-:#Medullary multiple myeloma
-:#Extramedullary multiple myeloma
-*Multiple myeloma may be classified according to clinical presentation into two subgroups:<ref name"wiki"=>Multiple myeloma. Wikipedia(2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Diagnostic_criteria Accessed on September, 20th 2015<nowiki></ref></nowiki><ref>Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref><ref>Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref>
-:#Active symptomatic multiple myeloma
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
-:#Smoldering asymptomatic multiple myeloma
+|valign=top|
+|+
+! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease}}
+! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Diagnostic Criteria}}
+! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Management Approach}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
+[[Solitary plasmacytoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+Biopsy of solid mass showing clonal plasma cells
+| style="padding: 5px 5px; background: #F5F5F5;" |
+Radiation therapy
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+[[Monoclonal gammopathy of undetermined significance]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*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
+| style="padding: 5px 5px; background: #F5F5F5;" |
+Monitoring of [[complete blood count]] every 6-12 months
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+[[Smoldering multiple myeloma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*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
+| style="padding: 5px 5px; background: #F5F5F5;" |
+Monitoring of [[complete blood count]] at specified intervals, depending on risk stratification
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
+[[Active multiple myeloma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*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
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*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==

Multiple myeloma classification: Difference between revisions

Revision as of 04:27, 15 July 2018

Overview

Classification

References

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