Info

🌱 來自: clinical manifestations of multiple myeloma (MM)

Diagnostic and staging evaluation of multiple myeloma

BM plasma cells ≥10% or bx-proven plasmacytoma

& ≥1 MM-defining event

• myeloma-related organ or tissue impairment (ROTI) = lytic bone lesions, Ca >11 mg/dL, Cr >2 mg/dL, or Hb <10 g/dL

• any of the following biomarkers: BM plasma cells ≥60%, serum free light chain (FLC) ratio ≥100:1, >1 focal lesion on MRI

Variants

1. Solitary bone or extramedullary plasmacytoma: no periph plasmacytosis or other ROTI
2. Plasma cell leukemia: plasma cell count >2000/µL in peripheral blood
3. Nonsecretory MM (~2% of MM Pts; MM without M protein)

• ✓ Peripheral smear for rouleaux ,
• Ca, alb, Cr; ↓ anion gap, ↑ globulin, ↑ ESR
• protein electrophoresis and immunofixation
• β2-microglobulin (β2M) and LDH levels reflect tumor burden

BM bx cytogenetics

• normal karyotype better than abnl.
• Standard risk 🟢 = hyperdiploidy or t(11;14);
• high risk 🔴 = hypodiploidy, del. 17p13 (~10% of Pts), t(4;14) & t(4;16).

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• Skeletal survey (plain X-rays) : to identify lytic bone lesions and areas at ↣ risk for pathologic fracture.
• Whole-body PET-CT (scalp to toe) or MRI often used to detect bone lesions.

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