In addition to the post below, please see my post, Laboratory Screening Tests for Suspected Multiple Myeloma From Mayo Medical Laboratories
Posted on November 29, 2018 by Tom Wade MD
The above figure is from Myeloma Explained Resource (1) below
The above figure is from Myeloma Explained Resource (1) below
The following are excerpts from Resource (1), Multiple Myeloma
Updated – Jan 11, 2018 Author: Dhaval Shah, MD:
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. First described in 1848, MM is characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein (M protein).
Multiple Myeloma Clinical Presentation
Presenting signs and symptoms of multiple myeloma (MM) include bone pain, pathologic fractures, weakness, anemia, infection (often pneumococcal), hypercalcemia, spinal cord compression, and renal failure. In approximately 30% of cases, MM is discovered through routine blood screening when patients are being evaluated for unrelated problems. Typically, a large gap between the total protein and the albumin levels observed on an automated chemistry panel suggests a problem (ie, protein minus albumin equals globulin).
In one third of patients, MM is diagnosed after a pathologic fracture occurs; such fractures commonly involve the axial skeleton. Two thirds of patients complain of bone pain, commonly with lower back pain. This bone pain is frequently located in the back, long bones, skull, and/or pelvis.
Patients may also complain of nonspecific constitutional symptoms related to hyperviscosity and hypercalcemia.
See Additional Resources below. There are links to Myeloma Patient Podcasts [Resource (2)], Myeloma Physician Podcasts [Resource (3)], Patient Myeloma Resources [Resource (4)], Patient Myeloma History Form [Resource (5)], and Myeloma Laboratory Evaluation Resources [Resources (6) and (7)].
I just reviewed Multiple Myeloma Updated: Jan 11, 2018 on the emedicine.medscape.com website. The article is excellent and well worth reading.
At the end of the above article, there is an excellent quick review section, Multiple Myeloma Questions & Answers Updated: Jan 11, 2018.
The above webpage has divided the Multiple Myeloma Questions And Answers into the following sections:
Overview Presentation Differential Diagnosis Workup Treatment
Guidelines Medications
Additional Resources:
(1) Multiple Myeloma from emedicine.medscape.com Updated – Jan 11, 2018 Author: Dhaval Shah, M
(2) Myeloma Explained Website from Amgen © 2018 Amgen Inc. All Rights Reserved
(3) Myeloma Crowd Radio Podcasts
Myeloma Crowd Radio brings you patient-led interviews of the world’s top multiple myeloma researchers. Call in live at showtime to (347) 637-2631 ask questions and to learn about the latest innovation in simple terms patients can understand.
Here is a podcast from the above series, Myeloma Crowd Radio: Dave Winfield and Don Baylor Jr. on your Most Valuable Plan 27 days ago 34:00:
In the World Series and the world of baseball, a strategy for success means planning ahead – doing everything you can to come out a winner. In the world of multiple myeloma, that means being your best advocate and coming up with your Most Valuable Plan. Which doctor will you choose, what treatments will you receive and in what order? Having a game plan is essential to making sure you stay in the game. Join us as we talk with twelve-time MLB All-Sar and Hall-of-Famer Dave Winfield, whose close friend and former teammate Don Baylor passed away following a 14-year old battle with the disease. Together with Don’s son, Don Baylor Jr., both are committed to helping raise awareness for this incurable blood cancer.
(4) Clinical Debates in Multiple Myeloma: Putting Evidence Into Context
This is an excellent podcast that can be helpful to patients as well as primary care physicians and oncologists.
Guest: Sagar Lonial, MD, FACP
The treatment armamentarium for multiple myeloma (MM) has expanded significantly in recent years, with 6 new agents or indications approved by the US Food & Drug Administration since 2015. Treatment options now include immunomodulatory drugs, proteasome inhibitors, a histone deacetylase inhibitor, and immunotherapies, making clinical decisions much more complex. Additionally, best practices and consensus guidelines, such as those from the National Comprehensive Cancer Network® (NCCN®) and International Myeloma Working Group (IMWG), are constantly evolving as new data are published. Approval of these new agents, revision of response criteria, and implementation of new approaches to risk assessment and monitoring residual disease are causing significant changes in the management of MM. This activity will review areas of current controversy and topics for which consensus is not yet established, including when to initiate treatment, determining transplant eligibility, high-risk disease, duration of maintenance therapy, sequencing newly approved drugs, and choice of treatment at relapse.
(4) Health Tree from The Myeloma Crowd – Find your best myeloma treatment options and help accelerate a cure for multiple myeloma.
Need help getting started? Print the Answers I Need Questionnaire and ask your care team to help you fill it out.
Explore your treatment options
Whether you’re newly diagnosed or your myeloma has come back, HealthTree shows available treatment options specifically for you.
Find clinical trials that are right for you
Find clinical trials that you qualify for based on your stage of disease and lab values.
Share your myeloma story to advance a cure
When we share our myeloma experience, we can see patterns of what works best for each patient and generate new ideas for a cure. The HealthTree Twin Machine™ technology will help connect you with patients in similar situations.
(5) HealthTree Multiple Myeloma Questionnaire
PLEASE ASK YOUR NURSE OR HEALTH CARE TEAM IF YOU NEED HELP COMPLETING THE FORM
The questionnaire asks the patient about:
PRIOR MYELOMA TREATMENT MYELOMA GENERAL QUESTIONS
MYELOMA GENETIC TESTS – FISH TEST
MYELOMA GENETIC TESTS – GENE EXPRESSION PROFILE TEST (GEP)
MYELOMA GENETIC TESTS – NEXT GENERATION SEQUENCING (NGS)
(6) Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel 3 [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Blood. 2011 May 5;117(18):4701-5. doi: 10.1182/blood-2010-10-299529. Epub 2011 Feb 3.
(7) ARUP Consult:
ARUP Consult® is a laboratory test selection support tool with more than 2,000 lab tests categorized into disease-related topics and algorithms.
Plasma Cell Dyscrasias – Laboratory Evaluation
Plasma cell dyscrasias are diseases of the hematologic system, the most common of which is multiple myeloma. Multiple myeloma can evolve from a premalignant monoclonal gammopathy. Monoclonal gammopathy of undetermined significance (MGUS) is present in 3-5% of adults older than 50 years and is characterized by low levels of monoclonal protein, low bone marrow involvement, and the absence of end-organ damage. Once a certain monoclonal protein threshold is reached, the disease is defined as smoldering myeloma, and once end-organ damage appears, the gammopathy has progressed to symptomatic myeloma. 1
Plasma cell dyscrasia evaluation begins with an investigation of the presence and type of monoclonal proteins (also known as M proteins). Serum free light chain (SFLC) quantification aids in diagnosing multiple myeloma and determining prognosis. 2 Bone marrow evaluation is essential for diagnosis. 1 Further testing can include flow cytometry and fluorescence in situ hybridization (FISH) to determine prognosis and cytogenetic studies to identify high-risk variants. 3
Here are the general site links:
