Multiple myeloma: Difference between revisions
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** Anemia with hemoglobin <100 g/L |
** Anemia with hemoglobin <100 g/L |
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** Bony lytic lesions |
** Bony lytic lesions |
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| + | == Clinical Manifestations == |
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| + | === Complications === |
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== Diagnosis == |
== Diagnosis == |
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** Add low-dose whole-body CT or MRI for smoldering myeloma and solitary plasmacytoma |
** Add low-dose whole-body CT or MRI for smoldering myeloma and solitary plasmacytoma |
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| − | == |
+ | == Management == |
| + | === Antimicrobial Prophylaxis === |
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| + | * [[Levofloxacin]] 500 mg p.o. daily for the first 12 weeks after starting chemotherapy may reduce mortality<ref>Drayson MT, Bowcock S, Planche T, Iqbal G, Pratt G, Yong K, Wood J, Raynes K, Higgins H, Dawkins B, Meads D, Hulme CT, Monahan I, Karunanithi K, Dignum H, Belsham E, Neilson J, Harrison B, Lokare A, Campbell G, Hamblin M, Hawkey P, Whittaker AC, Low E, Dunn JA; TEAMM Trial Management Group and Trial Investigators. Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Oncol. 2019 Dec;20(12):1760-1772. doi: [https://doi.org/10.1016/S1470-2045(19)30506-6 10.1016/S1470-2045(19)30506-6]. Epub 2019 Oct 23. PMID: [https://pubmed.ncbi.nlm.nih.gov/31668592/ 31668592]; PMCID: [https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31668592/ PMC6891230].</ref> |
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[[Category:Hematology]] |
[[Category:Hematology]] |
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Latest revision as of 09:09, 12 September 2022
Definition
- Monoclonal proliferation of plasma cell line causing disease
Classification
Monoclonal gammopathy of unknown significance (MGUS)
- M-protein present but <30 g/L, and
- Plasma cells <10% of bone marrow
- Absence of multiple myeloma end-organ damage
- If IgM, must also have no symptoms of a proliferative disorder or hyperviscosity
- Must think about Waldenstrom macroglobulinemia
Smoldering myeloma
- IgG or IgA M-protein >30 g/L or urinary M-protein (Bence-Jones) >500 mg/24h or plasma cells 10-60%
- Absence of multiple myeloma end-organ damage
Multiple myeloma
- SLiM CRAB symptoms
- Sixty percent plasma cells in marrow
- Light chain ratio (κ:λ or λ:κ) >100
- MRI showing at least two focal lesions
- Hypercalcemia >2.75 mmol/L
- Renal failure with creatinine >177 µmol/L or CrCl <40 mL/min
- Anemia with hemoglobin <100 g/L
- Bony lytic lesions
Clinical Manifestations
Complications
- Acute kidney injury
- Light chain deposition
- Hypercalcemia
- Urate crystals
- Amyloid deposition
- Myeloma infiltration
Diagnosis
- Routine bloodwork
- CBC with peripheral blood film, for anemia
- Calcium and creatinine
- SPEP with immunofixation
- Quantitative immunoglobulins
- Urinalysis
- UPEP with immunofixation
- Bone marrow biopsy
- Imaging
- Bone survey including spine, pelvis, skull, humeri, and femurs
- Add low-dose whole-body CT or MRI for smoldering myeloma and solitary plasmacytoma
Management
Antimicrobial Prophylaxis
- Levofloxacin 500 mg p.o. daily for the first 12 weeks after starting chemotherapy may reduce mortality[1]
- ↑ Drayson MT, Bowcock S, Planche T, Iqbal G, Pratt G, Yong K, Wood J, Raynes K, Higgins H, Dawkins B, Meads D, Hulme CT, Monahan I, Karunanithi K, Dignum H, Belsham E, Neilson J, Harrison B, Lokare A, Campbell G, Hamblin M, Hawkey P, Whittaker AC, Low E, Dunn JA; TEAMM Trial Management Group and Trial Investigators. Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Oncol. 2019 Dec;20(12):1760-1772. doi: 10.1016/S1470-2045(19)30506-6. Epub 2019 Oct 23. PMID: 31668592; PMCID: PMC6891230.
