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MYELOMA

Dec 05, 20232 min read

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🌱來自: snippets

MYELOMA

Symptomatic multiple myeloma, Ig? lambda/kappa, ISS I-III, Durie-Salmon I-IIIAB

  • Initial presentation:
  • WOrk up: check LDH, Ca, Alb, B2-microglobulin, sPEP, sIFE, uPEP, uIFE, serum FLC, IgG, IgA, IgM, urine 24hr total protein, skeletal survey, bone marrow study, flowcytometry, cytogenetics, FISH if possible
  • Other workup if clinically indicated: MRI, CT scan (avoid contrast), PET/CT, tissue diagnosis if plasmacytoma, staining of marrow and fat pad for amyloid, serum viscosity, HLA typing
  • Follow up parameters: PEP, IFE, CBC-DC, Bun, Cr, Ca, bone survey annually or s/s, bone marrow biopsy, sFLC, MRI/PET/CT if indicated.
  • Treatment plan: candidate for transplantation: induction with VTD X 4 cycles (Bortezomib 1.3mg/m2 SC on D1,8,15,22, thalidomide 100mg QD, Dexamethasone 20mg D1-2, 8-9, 15-16, 22-23 QW, every 5 weeks) ⇒ auto PBSCT ⇒ consolidation VTD x 4 cycles; adjunt treatment with bisphosphonates
  • 2016/00/00 explain purpose of treatment is to cure but not 100%, need long term follow up, and @ myeloma work up: check lab and arrange bone marrow study to send for flowcytometry and chromosome @ apply velcade **explain AEs of treatment, such as peripheral sensory neuropathy, fatigue, emesis, diarrhea, myelosuppression, fever (40%), constipation, increased infection risk, osteoporosis

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