Primary care providers play a significant role in the diagnosis of multiple myeloma, a detrimental disease of insidious onset. Jan 11, 2016 myeloma classification monoclonal gammopathy of undetermined significance serum mprotein 3 gdl andor bone marrow plasma cells. International myeloma working group updated criteria for the. The diagnostic workup in a patient with suspected multiple myeloma should include a complete blood count with differential. International myeloma working group updated criteria for the diagnosis of multiple myeloma. Learn more about the symptoms, causes, diagnosis, risk factors, and treatment of multiple myeloma. Background multiple myeloma is characterised by the proliferation of malignant plasma cells within the bone marrow, which produce an abnormal monoclonal paraprotein and evidence of end organ damage. Revised imwg diagnostic criteria for multiple myeloma and smouldering multiple myeloma.
There has been remarkable progress made in the diagnosis and treatment of multiple myeloma mm. The underlying pathophysiologic phenomena of the clinical features include suppression of humoral and cellmediated immunity, elevation of il6, abnormalities of the bone marrow microenvironment, and increased. 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. The median survival of the disease has doubled as a result of several new active. The updated criteria for the diagnosis of myeloma represent a paradigm shift in the approach to myeloma and have considerable impact on the management of the disease. International myeloma working group updated criteria for the diagnosis of multiple myeloma previous article efficacy and safety of radium223 dichloride in patients with castrationresistant prostate cancer and symptomatic bone metastases, with or without previous docetaxel use.
First described in 1848, mm is characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein m protein. Diagnosis of multiple myeloma is based on the international myeloma working group guidelines table 3. New imwg diagnostic criteria allows earlier diagnosis ash. Updated diagnostic criteria and staging system for. The criteria for submitting multiple myeloma without burning are the following. Revised international myeloma working group diagnostic criteria for multiple myeloma and smouldering multiple myeloma definition of multiple myeloma clonal bone marrow plasma cells. Pdf most of the documents on the racgp website are in portable document format pdf. Multiple myeloma mm is a plasma cell dyscrasia characterized by terminally differentiated plasma cells, infiltration of the bone marrow by plasma cells, and the presence of a monoclonal immunoglobulin or immunoglobulin fragment in the serum andor urine. The plasma cells proliferate in the bone marrow and often results in extensive skeletal destruction with osteolytic lesions, osteopenia, andor pathologic fractures. Jun 12, 2018 the term smoldering multiple myeloma smm was first introduced in 1980 to identify a group of six patients with 10% or more plasma cells pcs in the bone marrow bm and no organ damage at. These new criteria add myelomadefining events, the presence of any one of. Updated diagnostic criteria and staging system for multiple. In 2015, an estimated 28,850 new cases of multiple myeloma were. Biopsyproven solitary lesion of bone or soft tissue with evidence.
The factors that help doctors evaluate and diagnose a disease are known as diagnostic criteria. Multiple myeloma is a malignancy of terminally differentiated plasma cells, and patients typically present with bone marrow infiltration of clonal plasma cells. Jul 11, 2016 multiple myeloma accounts for around 1% of all cancers worldwide and 1015% of all hematological neoplasms. The risk of progression from smoldering multiple myeloma to symptomatic disease is related to the proportion of bone marrow plasma cells and the serum monoclonal protein level at diagnosis. Multiple myeloma mm is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. The diagnostic criteria for multiple myeloma are based on the results of diagnostic tests done on specimens of blood, urine, bone, and bone marrow. Group revised the diagnostic criteria for multiple myeloma. Multiple myeloma diagnosis and treatment mayo clinic. Multiple myeloma diagnostic criteria calculator medscape. Multiple myeloma diagnosis diagnosis of multiple myeloma. International myeloma working group updated criteria for the diagnosis of multiple myeloma s vincent rajkumar, meletios a dimopoulos, antonio palumbo, joan blade, giampaolo merlini, mariavictoria mateos, shaji kumar, jens hillengass. Criteria for the classification monoclonal gammopathies, multiple myeloma and related disorders.
These updated esmo clinical practice guidelines cover the diagnosis and pathologymolecular biology, staging and risk assessment and response evaluation of multiple myeloma. Updated international myeloma working group criteria. Multiple myeloma can present with a wide constellation of symptoms including hypercalcaemia, anaemia, renal impairment andor bony pain. The diagnosis of multiple myeloma requires increased numbers of immature, abnormal. Diagnostic criteria multiple myeloma is defined as ardent asymptomatic or active symptomatic. Protein bensonjones 1 g 24 h andor clonal plasma cells of the bone marrow.
Consensus recommendations for standard investigative workup. In germany there are around 6500 new cases of multiple myeloma each year and it is the third most commonly occurring disease of the blood after leukemia and nonhodgkin lymphoma. Diagnostic criteria have been set to distinguish mgus from myeloma. International myeloma working group updated criteria for. Risk stratification of smoldering multiple myeloma. Multiple myeloma symptoms, diagnosis and treatment bmj. Jul 20, 2017 multiple myeloma a malignancy of terminally differentiated plasma cells is the second most common haematological malignancy. Updated diagnostic criteria and staging system for multiple myeloma. Multiple myeloma mm, also known as plasma cell myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. As it progresses, bone pain, bleeding, frequent infections, and anemia may occur.
New diagnostic criteria 29 options for patients who are not candidates for stem cell transplant 33 transplantation 36 radiation 41. Myeloma is synonymous with multiple myeloma and plasma cell myeloma. What are the imwg diagnostic criteria for solitary plasmacytoma. Because there is a high prevalence of mgus and because serum protein electrophoresis is frequently carried out, most people who have serum monoclonal proteins detected will not have myeloma but will have mgus. May 18, 2019 multiple myeloma treatment guidelines. Multiple myeloma accounts for 1% of all cancers and approximately 10% of all haematological malignancies. After your diagnosis its also important to have a strong support system. Theres no cure for multiple myeloma but with an early diagnosis and treatment, recovery is possible. Jun 12, 2019 multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Multiple myeloma is a malignant disease characterized by plasmacytosis, paraprotein production, bone lesions, hypercalcemia, susceptibility to infections, and renal impairment. Evaluation history and physical blood workup cbc with differential and platelet counts bun, creatinine electrolytes, calcium, albumin, ldh serum quantitative immunoglobulins serum protein electrophoresis and immunofixation. Criteria for a multiple myeloma diagnosis a physician can make a multiple myeloma diagnosis based on a physical exam, a patients symptoms, and findings from lab work, biopsies, and imaging studies. What are the international myeloma working group imwg.
Now considered a diagnostic criteria for multiple myeloma. This is a diagnostic criteria for patients suspected of multiple myeloma, that is based on a series of blood and urine determinations and on presence of malignant plasma cell tumor growing. Role of 18ffdg petct in the diagnosis and management of multiple myeloma and other plasma cell disorders. The calculator for multiple myeloma diagnostic criteria uses parameters to make a diagnosis. International myeloma working group imwg criteria for the diagnosis of multiple myeloma.
Objective multiple myeloma can pose a diagnostic challenge and this article highlights issues in diagnosis and provides an overview of management. The parameters include plasmacytoma on tissue biopsy, bone marrow plasmacytosis, m protein, urinary kappa or lambda excretion, marrow plasmacytosis, lytic bone lesions, evidence of a monoclonal protein, and hypoglobulinemia of normal proteins. Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells. The international myeloma working group guidelines recommend the following diagnostic studiesref128. The malignant plasma cells, or myeloma cells, accumulate in the bone marrow. Myeloma is a cancer of the plasma cells in the bone marrow. International myeloma working group imwg uniform response criteria for multiple myeloma 1 the international myeloma working group established the below criteria in order to. Tests to find multiple myeloma american cancer society. International myeloma working group consensus criteria for response and minimal residual disease assessment in multiple myeloma. These files will have pdf in brackets along with the filesize of the download. The major and minor criteria from the model are described in the following table.
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