-
Mount Sinai Beth Israel
clinical question 2015622 J Hospitalist Network
-
681 WBC 6800/L , Hb 10g/dl, MCV 92 fl, Plt 10/L , , BUN 40mg/dl,
Cre 2.8mg/dl, TP 8.2mg/dl, Alb 2.8mg/dl, Ca 7.0 mg/dl WBC, , ,
-
Clinical Question
-
Multiple Myeloma
1%13%
NEJM 2011; 364: 1046
-
Smoldering myeloma, MGUS (Smoldering myeloma)(MGUS)
-
B
-
11
IgM, IgA, IgG, IgE, IgD
11 (H)
(IgG), (IgA), (IgM) (IgD), (IgE)
(L)
-
111
(Light chain myeloma)
-
10%
Lancet Oncol 2014; 15: e538
-
CRAB Calcium Ca>11mg/dl1mg/dl Renal insufficiency CCr <
40ml/min Cre >2mg/dl Anemia Hb
-
73% 58% 48% 32% 28% 24%
Mayo Clin Proc. 2003;78(1):21
-
60% 100 MRI2
MMMM
Nat rev Clin Oncol 2012; 9: 494 NEJM 2011; 365: 474
-
Smoldering MM
(IgA, IgG)30g/L500mg/24
10-60%
Lancet Oncol 2014; 15: e538
-
Monoclonal gammopathy of undetermined clinical significance
(MGUS)
-
SPEP, UPEP) Immunofixation Free light chain assay
-
(TP)=(Alb)(Glb)
-
IgG, IgA, IgM, IgD, IgE
MM
-
Serum protein electrophoresis(SPEP)
, 1, 2, ,
(church spire: )(M)M
M
-
Urine protein electrophoresis(UPEP)
SPEP(24)SPEP
-
SPEP, UPEP IgD, IgEMMSPEP, UPEP
-
Immunofixation
SPEP, UPEPM
1, 1
IgG- MM
-
MM
IgG 52 % IgA 21 % 16% IgD 2% 2% IgM 0.5% 6.5%
Mayo Clin Proc 2003; 78: 21
-
Free light chain assay (, )
/ (Free Light Chain ratio: FLC ratio) 0.26-1.65
FLC1002MM
Leukemia 2008; 22: 1933
-
(M)
SPEP, UPEP M MM Immunofixation M Free light chain assay MM
-
()
MM
60%2MM
-
WBC, Hb, Hct, Plt, Na, K, Cl, BUN, Cre,
Ca, SPEP/UPEP with immunofixation, quantification of serum/urine
monoclonal protein, Free light chains
(cytogenetic analysis)FISH
XPMRI 2LDH
-
MM MM
MMCaIgG(8~12)
-
Take Home Message
CRAB
-
Clinical features, laboratory manifestations, and diagnosis
of
multiple myeloma: UPTODATE International Myeloma Working Group
updated criteria for the
diagnosis of multiple myeloma Lancet Oncol 2014; 15: e538
Diagnosis of smoldering multiple myeloma NEJM 2011; 365: 474
Redefining myeloma Nat Rev Clin Oncol 2012; 9: 494 Monoclona
gammopathy of Undertermined Significance NEJM
2006; 355: 2765 Multiple myeloma NEJM 2011; 364: 1046 Review of
1027 patients with newly diagnosed multiple
myeloma Mayo Clin Proc 2003; 78: 21
