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Multiple Myeloma. Diagnostic challenges and standard therapy.
1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Seminars in Hematology
|April 20, 2001
Summary
Diagnosing multiple myeloma (MM) requires distinguishing it from smoldering MM (SMM) and monoclonal gammopathy of undetermined significance (MGUS). The plasma cell labeling index aids differential diagnosis and risk stratification for MM complications.
Area of Science:
- Hematology
- Oncology
- Clinical Diagnosis
Background:
- Multiple myeloma (MM) diagnosis involves excluding conditions with plasma cell reactions or osteolytic lesions.
- Smoldering multiple myeloma (SMM) and monoclonal gammopathy of undetermined significance (MGUS) lack MM complications and do not require toxic treatments.
Purpose of the Study:
- To differentiate between active multiple myeloma (MM) and smoldering conditions (SMM/MGUS).
- To identify patients at high risk for MM complications using the plasma cell labeling index.
Main Methods:
- Differential diagnosis by excluding other disorders (e.g., rheumatoid arthritis, metastatic carcinoma).
- Utilizing the plasma cell labeling index to distinguish MM from SMM.
- Assessing circulating plasma cell counts in SMM/MGUS patients.
Main Results:
- A high plasma cell labeling index indicates a high risk of complications in MM patients.
- The labeling index can be low in active MM, necessitating careful interpretation.
- SMM/MGUS patients typically exhibit few or no circulating plasma cells.
Conclusions:
- The plasma cell labeling index is a valuable tool for differentiating MM from SMM and assessing complication risk.
- Early recognition and prompt management of complications like spinal cord compression are critical.
- Supportive care, including erythropoietin, hydration, vaccinations, and prophylactic antibiotics, is essential.