Multiple Myeloma Diagnosis

Diagnosis

• Diagnostic criteria:
  • Monoclonal protein (M-protein) in blood or urine
  • Bone marrow plasma cells ≥ 10%
  • Evidence of end-organ damage (e.g., anemia, bone lesions, hypercalcemia, kidney disease)
• Diagnostic tests:
  • Blood tests: complete blood count (CBC), serum protein electrophoresis (SPEP), serum free light chain (SFLC) assay
  • Urine tests: urine protein electrophoresis (UPEP), urine SFLC assay
  • Bone marrow biopsy and aspirate
  • Imaging studies: skeletal survey, PET/CT, MRI
• Staging systems:
  • International Staging System (ISS): based on β2-microglobulin and albumin levels
  • Revised ISS (R-ISS): incorporates lactate dehydrogenase (LDH) levels and high-risk chromosomal abnormalities

Treatment Options

• Induction therapy:
  • Combination of chemotherapy, immunomodulatory agents, and proteasome inhibitors
  • Examples: VRd (bortezomib, lenalidomide, dexamethasone), KRd (carfilzomib, lenalidomide, dexamethasone)
• Maintenance therapy:
  • Lenalidomide or bortezomib to prolong remission
• Targeted therapies:
  • Daratumumab (anti-CD38 monoclonal antibody)
  • Elotuzumab (anti-SLAMF7 monoclonal antibody)
  • Carfilzomib (proteasome inhibitor)
• Supportive care:
  • Bisphosphonates for bone disease
  • Erythropoietin for anemia

Symptom Management

• Pain management:
  • Opioids, NSAIDs, and bisphosphonates
  • Radiation therapy for bone pain
• Anemia management:
  • Erythropoietin, iron supplements, and transfusions
• Bone disease management:
  • Bisphosphonates, denosumab, and kyphoplasty
• Infection management:
  • Antibiotics and antiviral medications
  • Vaccination against pneumococcal and influenza infections

Relapsed/Refractory Disease

• Definition:
  • Relapsed: disease progression after initial response
  • Refractory: disease progression during or within 60 days of treatment
• Treatment options:
  • Re-treatment with previous regimens
  • Alternative regimens (e.g., pomalidomide, ixazomib)
  • Clinical trials

Stem Cell Transplant

• Autologous stem cell transplant (ASCT):
  • High-dose chemotherapy followed by infusion of patient's own stem cells
  • Improves response rates and prolongs progression-free survival
• Allogenic stem cell transplant:
  • High-dose chemotherapy followed by infusion of donor stem cells
  • May offer curative potential, but associated with higher risk of graft-versus-host disease (GVHD)

Diagnosis

• Monoclonal protein (M-protein) is present in blood or urine
• At least 10% of bone marrow cells are plasma cells
• Evidence of end-organ damage, such as anemia, bone lesions, hypercalcemia, or kidney disease, is present

Diagnostic Tests

• Complete blood count (CBC) and serum protein electrophoresis (SPEP) are performed on blood samples
• Urine protein electrophoresis (UPEP) and urine serum free light chain (SFLC) assay are performed on urine samples
• Bone marrow biopsy and aspirate are performed to examine bone marrow cells
• Imaging studies, such as skeletal survey, PET/CT, and MRI, are used to visualize the body

Staging Systems

• International Staging System (ISS) is based on β2-microglobulin and albumin levels
• Revised ISS (R-ISS) incorporates lactate dehydrogenase (LDH) levels and high-risk chromosomal abnormalities

Treatment Options

• Induction therapy combines chemotherapy, immunomodulatory agents, and proteasome inhibitors
• Examples of induction therapy regimens include VRd and KRd
• Maintenance therapy uses lenalidomide or bortezomib to prolong remission
• Targeted therapies include daratumumab, elotuzumab, and carfilzomib
• Supportive care involves bisphosphonates, erythropoietin, and transfusions

Symptom Management

• Pain management involves opioids, NSAIDs, bisphosphonates, and radiation therapy
• Anemia management involves erythropoietin, iron supplements, and transfusions
• Bone disease management involves bisphosphonates, denosumab, and kyphoplasty
• Infection management involves antibiotics, antiviral medications, and vaccination against pneumococcal and influenza infections

Relapsed/Refractory Disease

• Relapsed disease is defined as disease progression after initial response
• Refractory disease is defined as disease progression during or within 60 days of treatment
• Treatment options for relapsed/refractory disease include re-treatment with previous regimens, alternative regimens, and clinical trials

Stem Cell Transplant

• Autologous stem cell transplant (ASCT) involves high-dose chemotherapy followed by infusion of patient's own stem cells
• Allogenic stem cell transplant involves high-dose chemotherapy followed by infusion of donor stem cells

Definition and Overview

• Multiple myeloma is a type of cancer that affects the plasma cells in the bone marrow, characterized by abnormal proliferation of plasma cells.
• It is also known as Kahler's disease or myelomatosis.

Causes and Risk Factors

• Age is a significant risk factor, especially after 65.
• Having a family member with multiple myeloma increases the risk of developing the disease.
• Exposure to high levels of radiation and certain chemicals, such as benzene, is a risk factor.
• African Americans are more likely to develop multiple myeloma.

Symptoms

• Bone pain, especially in the back, hips, or ribs, is a common symptom.
• Fatigue, weakness, and recurring infections are also common symptoms.
• Anemia, characterized by low red blood cell count, is often present.
• Hypercalcemia, or high calcium levels, is another common symptom.
• Kidney problems are also a common symptom.

Diagnosis

• Complete blood count (CBC), blood chemistry tests, and serum protein electrophoresis (SPEP) are used in blood tests to diagnose multiple myeloma.
• Urine protein electrophoresis (UPEP) is used in urine tests to diagnose multiple myeloma.
• Bone marrow biopsy is used to examine bone marrow cells.
• Imaging tests, such as X-rays, CT scans, MRI scans, and PET scans, are used to diagnose multiple myeloma.

Staging and Prognosis

• Multiple myeloma is staged based on the severity of the disease, with Stage I being the least severe and Stage III being the most severe.
• Stage I has a 5-year survival rate of 62%, Stage II has a 5-year survival rate of 45%, and Stage III has a 5-year survival rate of 29%.

Treatment

• Chemotherapy, targeted therapy, and immunotherapy are used to kill cancer cells and manage symptoms.
• Stem cell transplantation is used to replace bone marrow with healthy stem cells.
• Supportive care is used to manage symptoms and side effects.

Complications

• Bone damage, including osteoporosis, fractures, and bone deformities, is a common complication.
• Kidney damage, including kidney failure and chronic kidney disease, is a common complication.
• Infections, including recurrent infections and sepsis, are a common complication.
• Anemia, characterized by low red blood cell count, is a common complication.
• Hypercalcemia, or high calcium levels, is a common complication.