M-protein in multiple myeloma
|
|
- Mariah Knight
- 7 years ago
- Views:
Transcription
1 M-protein in multiple myeloma Plasma cells produce immunoglobulins (also called gammaglobulins), which consist of a heavy chain (IgG, IgA, IgM, IgD or IgE) and a light chain (kappa or lambda) linked together. One plasma cell produces one type of immunoglobulin (for instance, IgA kappa or IgG kappa). Normally the body contains a variety of different plasma cells ( polyclonal ), so the immunoglobulins in the serum are also all different (polyclonal). In the case of multiple myeloma, the malignant cells are all copies of the same plasma cell (they are monoclonal ). Therefore the malignant plasma cells all produce the same (monoclonal) immunoglobulin. This monoclonal immunoglobulin is called M-protein or paraprotein and also consists of a heavy chain (most often IgG or IgA but also IgM, IgD or IgE) and a light chain (kappa or lambda). The amount of monoclonal immunoglobulin in the serum is used to measure the tumor load. The malignant cells may also produce free light chains, no longer bound to a heavy chain. These free light chains can be quantified in serum, however, most of the light chains are excreted in the urine. Light chains in urine are called urine M-protein or Bence-Jones. In case of light chain disease, the malignant plasma cells no longer produce complete immunoglobulines but only produce a light chain (kappa or lambda). In light chain disease the amount of urine M-protein (Bence-Jones) or amount of Free Light Chains (FLC-values) in serum are used to measure the tumor load. In case of non-secreting myeloma the malignant plasma cells do not produce quantifiable amounts of monoclonal immunoglobulin or free light chains. Consequently the tumorload can not be measured by the amount of M-protein in serum or urine, but instead is measured by the amount of plasma cells in bone marrow smears or, if bone marrow smears are not available, the amount of plasma cells in bone marrow biopsy. M-protein in Serum To determine the disease status in multiple myeloma, the amount of monoclonal immunoglobulin in the serum is measured in g/l. Generally the quantity of monoclonal immunoglobulin that is produced by the malignant cells is far greater than the amount of normal immunoglobulin produced by healthy plasma cells. Sometimes the lab will only measure the total amount of immunoglobulin of the type produced by the malignant cells (total involved Ig), which includes a portion of normal immunoglobulin. Version Page 1 of 10
2 Example: In a patient with multiple myeloma, the malignant plasma cells produce vast amounts of monoclonal IgG kappa. The serum M-protein is only the monoclonal IgG kappa. Total involved Ig is monoclonal IgG plus normal (polyclonal) IgG. Consequently the value total involved Ig cannot be less than the value serum M-protein. When the patient is in CR, there should be no more measurable monoclonal immunoglobulin, while total involved Ig may still be present: in that case it consists only of the portion normal immunoglobulin. It is not always clear from a lab report if it shows serum M-protein or total involved Ig. When in doubt, check with the lab. It is also possible to measure the amount of free light chains in serum (Free Light Chains, FLC). Generally either the kappa or lambda chain has high levels. The serum FLC levels are used as response criteria if serum and urine M-protein are not measurable. In order to confirm (s)cr the FLC ratio between kappa and lambda (kappa:lambda) should be within the normal range: Protein electrophoresis of serum is a quantitative test and measures the amount of M-protein in serum. Immunofixation of serum is a qualitative test to identify which type of monoclonal immunoglobulin is present and is either positive or negative. When the amount of monoclonal immunoglobulin measured by protein electrophoresis has become so low that it can no longer be measured, immunofixation can still be positive. To confirm a CR, immunofixation of serum must be negative. Sometimes the lab uses another method, namely Immunosubstraction. This method is less accurate. Please contact the HDC in case this method is used to confirm CR. M-protein in urine Urine M-protein is the amount of free light chains (kappa or lambda) in the urine. The most reliable method is by measuring the total amount in a 24 hr urine collection, but it can also be measured in a single sample as g/l. The values measured in 24 hr urine collection are more reliable, and hence to be preferred. In patients with light chain disease, urine M-protein measured in 24 hr urine is the main parameter to determine disease status. Only in case urine M-protein values are not available FLC values in serum can be used. Version Page 2 of 10
3 Protein electrophoresis of urine is a quantitative test and measures the amount of M-protein in urine. Immunofixation of urine is a qualitative test to identify which type of monoclonal immunoglobulin is present and is either positive or negative. When the amount of monoclonal immunoglobulin measured by protein electrophoresis has become so low that it can no longer be measured, immunofixation can still be positive. To confirm a CR, immunofixation of urine must be negative. Version Page 3 of 10
4 Evaluation of response and relapse in multiple myeloma trials For the more recent HOVON multiple myeloma trials starting with HO86 the response criteria have been changed compared to the older multiple myeloma trials. This document is based on the criteria established by the International Myeloma Working Group (IMWG), published 21APR2010. These criteria were adapted from the International Uniform Response Criteria for Multiple Myeloma by BGM Durie et al. (Leukemia (2006) 1-7). The changes compared to the old trials are: - the disappearance of Minimal Response (MR); - the disappearance of Progression from MR/PR; - the addition of stringent complete response (scr); - the addition of free light chain values and ration in serum (FLC); - the change from response category NC into stable disease (SD); - the change of the required confirmation of relapse or disease progression and/or the institution of any new therapy within six weeks into requirement of two consecutive assessments at any time before classification as relapse or disease progression and/or the institution of any new therapy; - The disappearance of response citerias bone plasmacytima and lytic bone lesions. The possible responses are: PR (Partial Response), VGPR (Very Good Partial Response) CR (Complete Response) and scr (stringent Complete Response). The possible relapse categories are Relapse from (s)cr and PD (Progressive Disease). If neither of the response or relapse categories are met response should be SD (Stable Disease). Partial Response A new PR requires all of the following: - serum M-protein reduction of 50 % compared to On Study value (immunofixation of serum need not be negative); - urine M-protein reduction of 90 % compared to On Study or urine M-protein < 0.2 g/24hrs (immunofixation of urine need not be negative); urine M-protein unknown is only accepted if MM is not light chain disease or if MM is light chain disease and serum FLC values are available; - if only FLC values are available: 50% decrease in the difference between involved and uninvolved FLC values; Version Page 4 of 10
5 - if serum and urine M-protein are not measurable, and serum free light assay is also not measurable, 50% reduction in plasma cells is required in place of M-protein, provided baseline bone marrow plasma cell percentage was 30%. This does not apply to the HO86 and HO87; - soft tissue plasmacytomas area reduction of 50 % compared to On Study; When the previous response was PR and none of the criteria for progressive disease are met, response remains PR. Very Good Partial Response A new VGPR requires all of the following: - all criteria of PR are met plus the following: - serum M-protein reduction of 90 % compared to On Study value (immunofixation of serum need not be negative); - urine M-protein < 0.1 g/24hrs (immunofixation of urine need not be negative); urine M- protein unknown is only accepted if MM is not light chain disease or if MM is light chain disease and serum FLC values are available; - if only FLC values are available: >90% decrease in the difference between involved and uninvolved FLC values; When the previous response was VGPR and none of the criteria for progressive disease are met, response remains VGPR. Complete Response A new CR requires all of the following: - all criteria of VGPR are met plus the following: - serum M-protein = 0; serum M-protein unknown is only accepted if immunofixation serum is negative; - immunofixation serum is negative; - urine M-protein = 0; urine M-protein unknown is only accepted if immunofixation urine is negative; - immunofixation urine is negative; immunofixation urine not done is only accepted if last known immunofixation was negative; Version Page 5 of 10
6 - last known plasma cells in bone marrow < 5 %. Confirmation of value plasma cells in bone marrow is not needed; - disappearance of any soft tissue plasmacytoma; When the previous response was CR and none of the criteria for relapse are met, response remains CR. Stringent Complete Response A new scr requires all of the following: - all criteria of CR are met plus the following: - normal FLC ratio ( ); - absence of clonal cells in bone marrow by immunohistochemistry or immunofluorescence; When the previous response was (s)cr and none of the criteria for relapse are met, response remains (s)cr. Relapse from (s)cr A Relapse from (s)cr must be reported if the previous response was (s)cr and any of the following: - serum M-protein > 0 or positive immunofixation serum; - urine M-protein > 0 or positive immunofixation urine; - plasma cells in bone marrow 5 %; - development of new soft tissue plasmacytoma(s); - appearance of new skeletal lesion(s) and/or increase in number or size of skeletal lesion(s) or bone plasmacytoma(s) compared to last known value; - hypercalcaemia. All relapse categories require two consecutive assessments made at anytime before classification as relapse and/or the institution of any new therapy. Otherwise response may remain (s)cr. In case of scr: relapse from scr is possible on the basis of a positive result of immunohistochemistry or immunofluorescence of bone marrow aspirate or biopsy. Version Page 6 of 10
7 A relapse must also be reported if the previous response was relapse and the criteria for (s)cr, VGPR, PR, and SD are not met. Clinical Relapse In the IMWG criteria Clinical Relapse is also defined. It is not used in calculation of time to progression or progression-free survival (e.g. in HOVON studies). It is listed in the IMWG criteria as something that can be reported optionally or for use in clinical practice. For your information the criteria for Clinical Relapse are listed below: Clinical relapse requires one or more of: Direct indicators of increasing disease and/or end organ dysfunction (CRAB features). - Development of new soft tissue plasmacytomas or bone lesions; - Definite increase in the size of existing plasmacytomas or bone lesions. A definite increase is defined as a 50% (and at least 1 cm) increase as measured serially by the sum of the products of the cross-diameters of the measurable lesion; - Hypercalcemia (> 11.5 mg/dl) [2.65 mmol/l]; - Decrease in haemoglobin of 2 g/dl [1.25 mmol/l]; - Rise in serum creatinine by 2 mg/dl or more [177 mmol/l or more]. Progressive disease (PD) PD must be reported if the previous response was either VGPR, PR, SD or PD and any of the following: - serum M-protein increase of > 5 g/l and > 25 % compared to nadir (increase of 10 g/l is sufficient for PD if starting M-protein is 50 g/l; - urine M-protein increase of > 0.2 g/24hrs and > 25 % compared to nadir; - if only FLC values are available: the absolute increase in the difference between involved and uninvolved FLC values must be >10 g/l; - plasma cells in bone marrow increase of > 25 % compared to nadir; the absolute percentage must be 10%; - Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; - Development of hypercalcaemia (corrected serum calcium >11.5 mg/dl or 2.65 mmol/l) that can be attributed solely to the plasma cell proliferative disorder. Version Page 7 of 10
8 All relapse categories require two consecutive assessments made at anytime before classification as relapse and/or the institution of any new therapy. Otherwise response may remain VGPR, PR or SD. PD must also be reported if the previous response was PD and the criteria for (s)cr, VGPR, PR, and SD are not met. Stable disease SD requires the following: - not meeting criteria for (s)cr, VGPR, PR or progressive disease Conventions used in response evaluation - When on protocol treatment all responses are compared to baseline values at On Study. - When a patient goes off protocol, all responses are still compared to On Study values until a relapse or progression (including the moment of going off treatment) is reported in follow up. At that time the values at relapse, progression or start of treatment off protocol become the new baseline values. Since these responses are no longer relevant for the study s endpoints they will be accepted at face value with the exception of CR or in case of unclarities. - Nadir is defined as the lowest value for a certain parameter since baseline. So it is the lowest value since On Study, until a relapse or progression is reported in follow up, when a new baseline is set and a new nadir can be established. - Once immunofixation of serum or urine is negative, it is considered to remain negative until proven otherwise (by positive immunofixation or presence of M-protein in blood or urine). - When immunofixation serum or urine is negative, serum M-protein or urine M-protein is considered 0. - If immunofixation is not done it is considered positive if all previous immunofixations were either positive or not done. - When immunofixation serum or urine is positive, but serum M-protein or urine M-protein is not quantifiable because it is less than the detection limit, serum M-protein or urine M- protein is considered very low but not completely absent. - Plasma cells in bone marrow will be taken from aspirate; only if aspirate is unknown the biopsy results are taken as substitute. Version Page 8 of 10
9 - When plasma cells in bone marrow were normal at the previous evaluation (including On Study) they will be considered still normal if they are unknown or not repeated. - If number of soft tissue plasmacytoma is unknown, it is regarded as not present. - If area of soft tissue plasmacytoma is unknown, it is regarded as not increased. - When only one value in centimeters is given for size of largest soft tissue plasmacytoma this value is squared to obtain the area, when two values are given these are multiplied to obtain the area. - If skeletal lesions are unknown they will be considered not increased. - If the number of skeletal lesions increases, but all other criteria for (s)cr, VGPR or PR are met and serum M-protein (or urine M-protein in case of light chain disease or plasma cells in bone marrow in case of non-secreting myeloma) is decreased compared to the previous evaluation (including On Study) response can still be (s)cr, VGPR or PR. - If the number of skeletal lesions increases, but serum M-protein (or urine M-protein in case of light chain disease or plasma cells in bone marrow in case of non-secreting myeloma) is increased but less than 5 g/l compared to the previous evaluation (including On Study) response can not be (s)cr, VGPR or PR. - The development of compression fractures does not exclude (s)cr, VGPR or PR and also may not indicate relapse from (s)cr or progressive disease (PD). - If number of bone plasmacytoma is unknown, it is regarded as not present. - If area of bone plasmacytoma is unknown, it is regarded as not increased. - When the tumor mass of a bone plasmacytoma disappears a skeletal lesion may remain that is not to be distinguished from a lytic bone lesion. This is not to be interpreted as an increase in skeletal lesions and therefore does not indicate relapse from (s)cr or progressive disease (PD). - Hypercalcaemia: calcium adjusted for albumin (add 0.02 mmol/l for every g/l albumin below 40) > 2.8 mmol/l not attributable to any other cause; no hypercalcaemia until proven otherwise, so if calcium is unknown hypercalcaemia is considered absent. Order of responses - PD is progressive disease and can follow after VGPR, PR, SD or PD. - After CR a response can only remain CR or become a relapse; the loss of CR to relapse overrules all other responses. - After scr a response can only remain scr or become a relapse; the loss of scr to relapse overrules all other responses. - After VGPR a response can only remain VGPR, improve to (s)cr or become progressive disease; the loss of VGPR to progressive disease overrules all other responses. Version Page 9 of 10
10 - After PR a response can only remain PR, improve to (s)cr or VGPR or become progressive disease; the loss of PR to progressive disease overrules all other responses. - Usually a relapse or progressive disease will prompt the end of protocol treatment and the end of response evaluation compared to On Study values. However, in some protocols (not HO86 and HO87) it is allowed to continue protocol treatment and it is possible to go from relapse or progressive disease to SD, PR, VGPR or (s)cr (compared to On Study values). When the next response evaluation after a relapse or progressive disease during protocol treatment does not comply with SD, PR, VGPR or (s)cr compared to On Study, the response remains relapse or progressive disease. - During follow up the moment of relapse, progressive disease or start treatment off protocol creates a new baseline value to which responses are compared. Conventions about order of responses mentioned above result in the following possible response orders: Previous Present response response (s)cr VGPR PR SD PD Relapse (s)cr x x VGPR x x x PR x x x x SD x x x x x PD x x x x x Relapse x x x x x x x = response allowed Remission status in follow up The remission status in follow up should always match the last known response evaluation. For specific study agreements see the relevant sections in the protocol. Version Page 10 of 10
Multiple Myeloma Patient s Booklet
1E Kent Ridge Road NUHS Tower Block, Level 7 Singapore 119228 Email : ncis@nuhs.edu.sg Website : www.ncis.com.sg LIKE US ON FACEBOOK www.facebook.com/ nationaluniversitycancerinstitutesingapore Multiple
More informationUNDERSTANDING MULTIPLE MYELOMA AND LABORATORY VALUES Benjamin Parsons, DO bmparson@gundersenhealth.org Gundersen Health System Center for Cancer and
UNDERSTANDING MULTIPLE MYELOMA AND LABORATORY VALUES Benjamin Parsons, DO bmparson@gundersenhealth.org Gundersen Health System Center for Cancer and Blood Disorders La Crosse, WI UNDERSTANDING MULTIPLE
More informationMultiple Myeloma Workshop- Tandem 2014
Multiple Myeloma Workshop- Tandem 2014 1) Review of Plasma Cell Disorders Asymptomatic (smoldering) myeloma M-protein in serum at myeloma levels (>3g/dL); and/or 10% or more clonal plasma cells in bone
More informationTABLE OF CONTENTS. Multiple Myeloma / Plasma Cell Leukemia Pre-HSCT Data
Instructions for Multiple Myeloma / Plasma Cell Leukemia Pre-HSCT Data (Form 2016) This section of the CIBMTR Forms Instruction Manual is intended to be a resource for completing the Multiple Myeloma /
More informationMultiple Myeloma How to Evaluate Response To Treatment and Relapse
Multiple Myeloma How to Evaluate Response To Treatment and Relapse D R L. G AR D E R E T Saint Antoine Hospital, Paris Haematology Department 1 What is Multiple Myeloma? 4 Diagnostic Tools 8 Response to
More informationMultiple Myeloma. The term multiple myeloma is considered to be synonymous with myeloma, plasma cell myeloma, active and symptomatic myeloma.
Multiple Myeloma. The term multiple myeloma is considered to be synonymous with myeloma, plasma cell myeloma, active and symptomatic myeloma. The intent is to positively identify patients with active or
More informationCurrent Multiple Myeloma Treatment Adapted From the NCCN Guidelines
Current Multiple Myeloma Treatment Adapted From the NCCN Guidelines Diagnosis Survival 3-5 yrs Survival
More informationUnderstanding Protein Electrophoresis
Understanding Protein Electrophoresis International Myeloma Foundation 12650 Riverside Drive, Suite 206 North Hollywood, CA 91607 USA Telephone: 800-452-CURE (2873) (USA & Canada) 818-487-7455 Fax: 818-487-7454
More informationUnderstanding Serum Free Light Chain Assays
Understanding Serum Free Light Chain Assays International Myeloma Foundation 12650 Riverside Drive, Suite 206 North Hollywood, CA 91607 USA Telephone: 800-452-CURE (2873) (USA & Canada) 818-487-7455 Fax:
More informationMULTIPLE MYELOMA Review & Update for Primary Care. Dr. Joseph Mignone 21st Century Oncology
MULTIPLE MYELOMA Review & Update for Primary Care Dr. Joseph Mignone 21st Century Oncology OVERVIEW Identify the diagnostic criteria for multiple myeloma Compare first & second line therapies, using data
More informationWhole Antibody and Free Light Chain Production by Plasma Cells
MYELOMA Very Good ; Stringent or Complete Navigating the maze of Responses Parameswaran Hari Medical College of Wisconsin Milwaukee Increasing understanding of disease biology in the last few years Deeper
More informationFastTest. You ve read the book... ... now test yourself
FastTest You ve read the book...... now test yourself To ensure you have learned the key points that will improve your patient care, read the authors questions below. Please refer back to relevant sections
More informationUnderstanding Protein Electrophoresis
Understanding Protein Electrophoresis International Myeloma Foundation 12650 Riverside Drive, Suite 206 North Hollywood, CA 91607 USA Telephone: 800-452-CURE (2873) (USA & Canada) 818-487-7455 Fax: 818-487-7454
More informationThings You Don t Want to Miss in Multiple Myeloma
Things You Don t Want to Miss in Multiple Myeloma Sreenivasa Chandana, MD, PhD Attending Hematologist and Medical Oncologist West Michigan Cancer Center Assistant Professor, Western Michigan University
More informationInvestigation of B cell malignancies. Dr. Joanna Sheldon Protein Reference Unit St. George s s Hospital
Investigation of B cell malignancies Dr. Joanna Sheldon Protein Reference Unit St. George s s Hospital The B cell progression from «Pluripotent stem cell «Lymphoid committed stem cell «B lineage committed
More informationMonoclonal Gammopathy of Undetermined Significance (MGUS) Facts
Monoclonal Gammopathy of Undetermined Significance (MGUS) Facts Normal plasma cells (a type of white blood cell) produce antibodies (also known as immunoglobulins) which help fight infection. Each type
More informationMalignant Lymphomas and Plasma Cell Myeloma
Malignant Lymphomas and Plasma Cell Myeloma Dr. Bruce F. Burns Dept. of Pathology and Lab Medicine Overview definitions - lymphoma lymphoproliferative disorder plasma cell myeloma pathogenesis - translocations
More informationInformation Pathway. Myeloma tests and investigations. Paraprotein measurement
Information Pathway Myeloma UK Broughton House 31 Dunedin Street Edinburgh EH7 4JG Tel: + 44 (0) 131 557 3332 Fax: + 44 (0) 131 557 9785 Myeloma Infoline 0800 980 3332 www.myeloma.org.uk Charity No. SC
More informationUse of free light chain analysis in the diagnosis, prognosis and therapy of multiple myeloma. Amitabha Mazumder, MD
Use of free light chain analysis in the diagnosis, prognosis and therapy of multiple myeloma Amitabha Mazumder, MD Monoclonal Gammopathies Multiple Myeloma 18% Light Chain Dep Ds < 1% AL Amyloidosis 9%
More informationMultiple Myeloma Making Sense of the Report Forms. Parameswaran Hari Medical College of Wisconsin Milwaukee
Hodgkin CML MDS/Other Leuk CLL Neuroblastoma Multiple Myeloma Making Sense of the Report Forms Parameswaran Hari Medical College of Wisconsin Milwaukee Indications for Blood and Marrow Transplantation
More informationNew diagnostic criteria for myeloma
New diagnostic criteria for myeloma Dr Guy Pratt Senior Lecturer/Honorary Consultant Haematologist University of Birmingham/Heart of England NHS Trust International Myeloma Working Group (IMWG) define
More informationMULTIPLE MYELOMA 1 PLASMA CELL DISORDERS Multiple l Myeloma Monoclonal Gammopathy of Undetermined Significance (MGUS) Smoldering Multiple Myeloma (SMM) Solitary Plasmacytoma Waldenstrom s Macroglobulinemia
More informationSOUTHWEST ONCOLOGY GROUP CLINICAL RESEARCH ASSOCIATE (CRA) MANUAL. MYELOMA CHAPTER 10 REVISED: March 2008
Introduction This disease site includes the following three malignancies: multiple myeloma, amyloidosis, and waldenstrom's macroglobulinemia. See pages 4 and 5 for descriptions of the latter two diseases.
More informationchronic leukemia lymphoma myeloma differentiated 14 September 1999 Pre- Transformed Ig Surface Surface Secreted Myeloma Major malignant counterpart
Disease Usual phenotype acute leukemia precursor chronic leukemia lymphoma myeloma differentiated Pre- B-cell B-cell Transformed B-cell Plasma cell Ig Surface Surface Secreted Major malignant counterpart
More informationNON SECRETORY MULTIPLE MYELOMA A CASE REPORT
NON SECRETORY MULTIPLE MYELOMA A CASE REPORT Golwilkar A.,*Saluja R., Mehendale A. and Jalnapurkar N. Department of Histopathology, Golwilkar Metropolis Health Services (India) Pvt Ltd *Author for Correspondence
More informationPlasma cell dyscrasias Mark Drayson
Plasma cell dyscrasias Mark Drayson Mortality statistics for England and Wales. Deaths attributed to multiple myeloma from 1988-1997 by age cohort as a percentage of total (21,257) deaths Deaths in age
More informationStem Cell Transplantation
Harmony Behavioral Health, Inc. Harmony Behavioral Health of Florida, Inc. Harmony Health Plan of Illinois, Inc. HealthEase of Florida, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance
More informationGlossary of Multiple Myeloma Terms
Some things that make multiple myeloma (MM) difficult to understand are the unfamiliar medical terms that some experts and healthcare providers use to explain it. You may come across words like these when
More informationI've Just Been Diagnosed. with Multiple Myeloma, What s Next?
I've Just Been Diagnosed with Multiple Myeloma, What s Next? Table of Contents Message from a Survivor Introduction What is Multiple Myeloma? What Causes Multiple Myeloma? Genes & Multiple Myeloma What
More informationHOVON Staging and Response Criteria for Non-Hodgkin s Lymphomas Page 1
HOVON Staging and Response Criteria for Non-Hodgkin s Lymphomas Page 1 This document describes the minimally required staging and evaluation procedures and response criteria that will be applied in all
More informationA Diagnostic Chest XRay: Multiple Myeloma
Daniela Marinho Tridente, VI FCMSCSP October 2013 A Diagnostic Chest XRay: Multiple Myeloma Daniela Marinho Tridente, VI FCMSCSP Our Learning Agenda Introduction of our patient His imaging data and findings
More informationChapter 2. S. Hovenga 1, J.Th.M. de Wolf 1, J.E.J. Guikema 4, H. Klip 2, J.W. Smit 3, C.Th. Smit Sibinga 5, N.A. Bos 4, E.
Chapter 2 Autologous stem cell transplantation in multiple myeloma after VAD and EDAP courses; a high incidence of oligoclonal serum immunoglobulins post transplantation S. Hovenga, J.Th.M. de Wolf, J.E.J.
More informationMyeloma pathways to diagnosis UCLP audit
Myeloma pathways to diagnosis UCLP audit Dr Neil Rabin Consultant Haematologist University College London Hospitals & North Middlesex University Hospital Myeloma Clinical Features Bone pain (70%) High
More informationMansour Al-Hiary MD *, Baheieh Al-Abbadi MD*, Nesreen Abu Hazeem MD*, Ali Swailmeen MD**, Najah Aldrous MD*, Nazmi Kamal MD* ABSTRACT
Pattern of Serum Protein Electrophoresis Results in a Group of Patients with Plasma Cell Myeloma Confirmed by Bone Marrow Findings at King Hussein Medical Center Mansour Al-Hiary MD *, Baheieh Al-Abbadi
More informationThe following investigations are required at diagnosis, so that a disease category and stage can be assigned (see below).
3 MULTIPLE MYELOMA Clinical features Multiple myeloma (MM) is a disease with a peak incidence in the 6 th and seventh decades of life, but can also occur in younger patients. It is characterised by infiltration
More informationProteins. Protein Trivia. Optimizing electrophoresis
Proteins ELECTROPHORESIS Separation of a charged particle in an electric field Michael A. Pesce, Ph.D Department of Pathology New York-Presbyterian Hospital Columbia University Medical Center Rate of migration
More informationA Clinical Primer. for Managed Care Stakeholders
reviews therapy Diagnosing, Staging, and Treating Multiple Myeloma: A Clinical Primer for Managed Care Stakeholders by Ralph V. Boccia, MD, FACP, Medical Director, Center for Cancer and Blood Disorders
More informationNATIONAL CANCER INSTITUTE. Lenalidomide or Observation in Treating Patients With Asymptomatic High-Risk Smoldering Multiple Myeloma
NATIONAL CANCER INSTITUTE Lenalidomide or Observation in Treating Patients With Asymptomatic High-Risk Smoldering Multiple Myeloma Basic Trial Information Phase Type Status Age Sponsor Protocol IDs Phase
More informationKharkov Regional Centre of Cardiovascular surgery V.N. Karazin Kharkov National University Department of Internal Medicine.
Kharkov Regional Centre of Cardiovascular surgery V.N. Karazin Kharkov National University Department of Internal Medicine Multiple Myeloma Associate professor Abduyeva F.M., MD, PhD 2014 Definition Multiple
More informationSWOG ONCOLOGY RESEARCH PROFESSIONAL (ORP) MANUAL VOLUME I RESPONSE ASSESSMENT LEUKEMIA CHAPTER 11A REVISED: OCTOBER 2015
LEUKEMIA Response in Acute Myeloid Leukemia (AML) Response criteria in Acute Myeloid Leukemia for SWOG protocols is based on the review article Diagnosis and management of acute myeloid leukemia in adults:
More informationPro Cure in Multiple Myeloma. Nicolaus Kröger Dept. of Stem Cell Transplantation University Hospital Hamburg Hamburg, Germany
Pro Cure in Multiple Myeloma Nicolaus Kröger Dept. of Stem Cell Transplantation University Hospital Hamburg Hamburg, Germany Pro Cure in Multiple Myeloma Several hematological malignancies can be cured
More information1.5 Function of analyte For albumin, see separate entry. The immunoglobulins are components of the humoral arm of the immune system.
Total protein (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Total protein 1.2 Alternative names None 1.3 NMLC code 1.4 Description of analyte This is a quantitative measurement
More informationCA 125 definitions agreed by GCIG November 2005
CA 125 definitions agreed by GCIG November 2005 The GCIG has agreed criteria for defining response and progression of ovarian carcinoma which use the serum marker CA 125, and the situations where these
More informationRadiotherapy in Plasmacytoma and Myeloma. David Cutter Multiple Myeloma NSSG Annual Meeting 14 th September 2015
Radiotherapy in Plasmacytoma and Myeloma David Cutter Multiple Myeloma NSSG Annual Meeting 14 th September 2015 Contents Indications for radiotherapy: Palliation in Multiple Myeloma Solitary Bone Plasmacytoma
More informationOutline. Question 1. Question 2. What is Multiple Myeloma? Andrew Eisenberger, MD
Outline A Disease Overview June 3, 2013 Andrew Eisenberger, MD Assistant Professor of Medicine Hematology/Oncology Columbia Presbyterian Medical Center Introduction Epidemiology/Risk Factors Clinical Features/Diagnostic
More informationGuidelines on the diagnosis and management of multiple myeloma
Guidelines on the diagnosis and management of multiple myeloma British Committee for Standards in Haematology in conjunction with the UK Myeloma Forum (UKMF) Address for correspondence: BCSH Secretary
More informationMyeloma. A guide for patients and families. 1800 620 420 leukaemia.org.au
Myeloma A guide for patients and families 1800 620 420 leukaemia.org.au Notes Contents Acknowledgments 4 Introduction 5 The Leukaemia Foundation 6 Blood cancers 10 What is myeloma? 16 Who gets myeloma?
More informationMultiple Myeloma Patient Handbook. www.myeloma.ca
Multiple Myeloma Patient Handbook www.myeloma.ca Introduction This resource has been designed for: 1. Someone who has been newly diagnosed with myeloma and is wondering what it means and what the future
More informationMULTIPLE MYELOMA. Overview
MULTIPLE MYELOMA Overview Steven R. Schuster, M.D. May 7, 2015 Objectives Give an overview of Multiple Myeloma Everything I know in 15 minutes Explain how genetic information can be used to personalize
More informationIntérêt t clinique de l'identification des
Intérêt t clinique de l'identification des chaînes légères l libres Jean-Fran François Lambert Hematologie - CHUV Healthy 69 yo female Negative past medical history 2/07 acute pulmonary edema Progressive
More informationDARATUMUMAB, A CD38 MONOCLONAL ANTIBODY IN PATIENTS WITH MULTIPLE MYELOMA - DATA FROM A DOSE- ESCALATION PHASE I/II STUDY
DARATUMUMAB, A CD38 MONOCLONAL ANTIBODY IN PATIENTS WITH MULTIPLE MYELOMA - DATA FROM A DOSE- ESCALATION PHASE I/II STUDY Torben Plesner, Henk Lokhorst, Peter Gimsing, Hareth Nahi, Steen Lisby, Paul Richardson
More informationCollaboration to collect Autologous transplant outcomes in Lymphoma and Myeloma (CALM) Additional Questionnaire (MED C) INCLUSION CRITERIA CALM STUDY
Additional Questionnaire (MED C) CALM study Inclusion period: 01/01/2008 to 31/12/2011 PATIENT REGISTRATION FORM Disease Diagnosis Lymphoma S Non Hodgkin Lymphoma (NHL) Mature B-cell neoplasm Follicular
More informationHaematological Features and Serum Protein Pattern on Electrophoresis of Multiple Myeloma in Sudanese Patients
Pyrex Journal of Clinical Pathology and Forensic Medicine Vol 1 (2) pp. 009-016 November, 2015 http:///pjcpfm Copyright 2015 Pyrex Journals Original Research Article Haematological Features and Serum Protein
More informationTHE MANY FACES OF MONOCLONAL GAMMOPATHIES
THE MANY FACES OF MONOCLONAL GAMMOPATHIES Marion S. Sternbach, MD, FRCP(C), FACP Presented at Medicine Grand Rounds, St Joseph s Hospital Sept 19, 2007 Monoclonal Gammopathies Objectives. 1. Getting acquainted
More informationPatient Handbook. Multiple Myeloma. International Myeloma Foundation. Until There is a Cure... There is the IMF. Cancer of the Bone Marrow
Until There is a Cure... There is the IMF. Patient Handbook Published by the International Myeloma Foundation (IMF) International Myeloma Foundation 12650 Riverside Drive, Suite 206 North Hollywood, CA
More informationA novel molecular mechanism involved in cancer development revealed by targeting MafB to hematopoietic progenitors
A novel molecular mechanism involved in cancer development revealed by targeting MafB to hematopoietic progenitors Carolina Vicente Dueñas Instituto de Biología Molecular y Celular del Cáncer (IBMCC) (CSIC-Universidad
More informationContinuing Medical Education Article Imaging of Multiple Myeloma and Related Plasma Cell Dyscrasias JNM, July 2012, Volume 53, Number 7
Continuing Medical Education Article Imaging of Multiple Myeloma and Related Plasma Cell Dyscrasias JNM, July 2012, Volume 53, Number 7 Authors Ronald C. Walker 1,2, Tracy L. Brown 3, Laurie B. Jones-Jackson
More informationExtramedullary Plasmacytoma
Extramedullary Plasmacytoma Carole Fakhry MD MPH The Milton J. Dance, Jr. Head and Neck Center at GBMC HEAD AND NECK GRAND ROUNDS 9-5-2008, Baltimore, Maryland Plasmacytoma Monoclonal proliferation of
More informationTable of Contents Accelerate Your Research Introduction I. From the Real World to the Lab II. Research Challenges III. How Can Conversant Bio Help?
Table of Contents Accelerate Your Research 2 Introduction 3 I. From the Real World to the Lab 4 A. Diagnosing Multiple Myeloma 4 1. Lab Tests 4 2. Bone Marrow Exams 6 3. Imaging Studies 7 B. Subtypes of
More informationWaldenström Macroglobulinemia: The Burning Questions. IWMF Ed Forum May 18 2014 Morie Gertz MD, MACP
Waldenström Macroglobulinemia: The Burning Questions IWMF Ed Forum May 18 2014 Morie Gertz MD, MACP Are my kids going to get this? Familial seen in approximately 5 10% of all CLL patients and can be associated
More informationNCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) Multiple Myeloma. Version 1.2011. NCCN.org
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) Version 1.2011 NCCN.org The NCCN Guidelines are a statement of evidence and consensus of the authors regarding their views of currently
More informationSerum Protein Electrophoresis
Serum Protein Electrophoresis Karina Rodriguez-Capote MD, PhD, FCACB, Clinical Chemist, DynaLIFE Dx 2013 Laboratory Medicine Symposium Objectives Describe the electrophoresis procedure used to separate
More informationMyeloma. A guide for patients, families and whanau
Myeloma A guide for patients, families and whanau The Leukaemia & Blood Foundation is grateful to Janssen for sponsoring this booklet 1 CONTENTS PAGE Introduction 2 The Leukaemia & Blood Foundation 3 Bone
More informationMULTIPLE MYELOMA. Dr Malkit S Riyat. MBChB, FRCPath(UK) Consultant Haematologist
MULTIPLE MYELOMA Dr Malkit S Riyat MBChB, FRCPath(UK) Consultant Haematologist Multiple myeloma is an incurable malignancy that arises from postgerminal centre, somatically hypermutated B cells.
More informationMyeloma. Ann Grace, myeloma survivor. This publication was supported in part by a grant from
Myeloma Ann Grace, myeloma survivor This publication was supported in part by a grant from Revised 2013 A Message From John Walter President and CEO of The Leukemia & Lymphoma Society The Leukemia & Lymphoma
More informationResponse Criteria for Malignant Lymphoma 2007. Cheson Criteria. Quick Reference Guide
Response Criteria for Malignant Lymphoma 2007 Cheson Criteria Quick Reference Guide Table of Contents Summary of Assessments...3 Baseline Lesion Burden...4 What isameasurable Lesion?...5 Choosing Target
More informationMyeloma. Anne Grace, myeloma survivor. Support for this publication provided by
Myeloma Anne Grace, myeloma survivor Support for this publication provided by Revised 2015 Publication Update Myeloma The Leukemia & Lymphoma Society wants you to have the most up-to-date information about
More informationMultiple. Powerful thinking advances the cure
Multiple Myeloma DISEASE OVERVIEW Powerful thinking advances the cure Powerful thinking advances the cure About the Multiple Myeloma Research Foundation The Multiple Myeloma Research Foundation (MMRF)
More informationLymphoplasmacytic Lymphoma. Hematology fellows conference 4/12/2013 Christina Fitzmaurice, MD, MPH
Lymphoplasmacytic Lymphoma versus IGM Multiple Myeloma Hematology fellows conference 4/12/2013 Christina Fitzmaurice, MD, MPH Hematology consult patient 48 yo woman presents to ER with nonspecific complaints:
More informationMultiple Myeloma in HUSM. Dr Azlan Husin HUSM
Multiple Myeloma in HUSM Dr Azlan Husin HUSM Outline Overview Presenting features Progress in myeloma Global HUSM Multiple myeloma is a neoplastic plasma-cell disorder that is characterized by clonal proliferation
More informationHenk Lokhorst, Torben Plesner, Peter Gimsing, Hareth Nahi, Steen Lisby, Paul Richardson
DRTUMUMB, a CD38 Monoclonal ntibody Study in dvanced Multiple Myeloma an Open-Label, Dose Escalation Followed by Open-Label Extension in a Single-rm Phase I/II Study bstract #S576 Henk Lokhorst, Torben
More informationPATIENT HANDBOOK. Multiple Myeloma. Improving Lives Finding the Cure. Cancer of the Bone Marrow. Prepared by Brian G.M. Durie, M.D.
PATIENT HANDBOOK A Publication of the International Myeloma Foundation Dedicated to improving the quality of life of myeloma patients while working toward prevention and a cure. Prepared by Brian G.M.
More informationDate for guideline review January 2010. Avon Haematology Unit, Bristol Haematology and Oncology Centre, Bristol
UK Myeloma Forum (UKMF) and Nordic Myeloma Study Group (NMSG): Guidelines for the investigation of newly detected M-proteins and the management of Monoclonal Gammopathy of Undetermined Significance (MGUS)
More informationMYEL NEWL OMA Y DIA GNOSED
Information on NEWLY DIAGNOSED MYELOMA UAMS 1 ABOUT THE MYELOMA INSTITUTE The Myeloma Institute at the University of Arkansas for Medical Sciences (UAMS) is a leading center in the world for comprehensive
More informationDECIPHERING MY MYELOMA LAB RESULTS
Myeloma DECIPHERING MY MYELOMA LAB RESULTS Do you understand your myeloma diagnosis and your myeloma lab results? This guide attempts to simplify the complex process of understanding your myeloma markers
More informationThe Management of Myeloma & Plasma Cell Disorders
Kent & Medway - Cancer The Management of Myeloma & Plasma Cell Disorders Oncological Treatment Guidelines for the Management of Multiple Myeloma and other Plasma Cell Disorders & Pathway of Care Publication
More informationMonitoring Residual Myeloma High-Resolution Serum/Urine Electrophoresis or Marrow Biopsy With Immunohistochemical Analysis?
Hematopathology / Residual Disease Monitoring in Myeloma Monitoring Residual Myeloma High-Resolution Serum/Urine Electrophoresis or Marrow Biopsy With Immunohistochemical Analysis? Amanda D. Tatsas, MD,
More information6/20/2014. PART I: Plasma Cell Myeloma. Plasma Cells
MULTIPLE MYELOMA: THE TESTING, VALIDATION AND IMPLEMENTATION OF CELL SEPARATION TECHNOLOGY FOR IMPROVED PATIENT CARE Elizabeth Harper CG(ASCP), Binh Vo CG(ASCP), Joey Pena CG(ASCP), Denise Lovshe CG(ASCP),
More informationMultiple. Powerful thinking advances the cure
Multiple Myeloma Treatment OVERVIEW Powerful thinking advances the cure Powerful thinking advances the cure About the Multiple Myeloma Research Foundation The Multiple Myeloma Research Foundation (MMRF)
More informationThe Role of Bisphosphonates in Multiple Myeloma: 2007 Update Clinical Practice Guideline
The Role of Bisphosphonates in Multiple Myeloma: 2007 Update Clinical Practice Guideline Introduction ASCO convened an Update Committee to review and update the 2002 recommendations for the role of bisphosphonates
More informationMultiple myeloma: challenges of management in a developing country
Journal of Medicine and Medical Sciences Vol. 3(6) pp. 397-403, June 2012 Available online http://www.interesjournals.org/jmms Copyright 2012 International Research Journals Full Length Research Paper
More informationMultiple Myeloma. This reference summary will help you understand multiple myeloma and its treatment options.
Multiple Myeloma Introduction Multiple myeloma is a type of cancer that affects white blood cells. Each year, thousands of people find out that they have multiple myeloma. This reference summary will help
More informationTITLE: Protein Testing in Patients with Multiple Myeloma: A Review of Clinical Effectiveness and Guidelines
TITLE: Protein Testing in Patients with Multiple Myeloma: A Review of Clinical Effectiveness and Guidelines DATE: 09 January 2015 CONTEXT AND POLICY ISSUES Multiple myeloma (MM) is a hematological cancer
More informationDECIPHERING MY MYELOMA LAB RESULTS
DECIPHERING MY MYELOMA LAB RESULTS mpatient Myeloma Do you understand your myeloma diagnosis and your myeloma lab results? This guide attempts to simplify the complex process of understanding your myeloma
More informationNCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines. Multiple Myeloma. Version 2.2014. NCCN.org. Continue
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) Version 2.2014 NCCN.org Continue Version 2.2014, 11/08/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN
More informationInteresting Case Review. Renuka Agrawal, MD Dept. of Pathology City of Hope National Medical Center Duarte, CA
Interesting Case Review Renuka Agrawal, MD Dept. of Pathology City of Hope National Medical Center Duarte, CA History 63 y/o male with h/o CLL for 10 years Presents with worsening renal function and hypercalcemia
More informationFEIST- WEILLER CANCER CENTER MULTIPLE MYELOMA GUIDELINES. Updated December, 2011. Authors: Nebu Koshy, MD. Binu Nair, MD. Gerhard Hildebrandt, MD
FEIST- WEILLER CANCER CENTER MULTIPLE MYELOMA GUIDELINES Updated December, 2011 Authors: Nebu Koshy, MD Binu Nair, MD Gerhard Hildebrandt, MD Reinhold Munker, MD Glenn Mills, MD Mandatory initial tests
More informationPulling the Plug on Cancer Cell Communication. Stephen M. Ansell, MD, PhD Mayo Clinic
Pulling the Plug on Cancer Cell Communication Stephen M. Ansell, MD, PhD Mayo Clinic Why do Waldenstrom s cells need to communicate? Waldenstrom s cells need activating signals to stay alive. WM cells
More informationEvolving Management of Multiple Myeloma: 2015. Todd M. Zimmerman, M.D. Associate Professor of Medicine Section of Hematology/Oncology
Evolving Management of Multiple Myeloma: 2015 Todd M. Zimmerman, M.D. Associate Professor of Medicine Section of Hematology/Oncology MULTIPLE MYELOMA Estimated 24,050 cases and 11,090 deaths in 2014 [1]
More informationfor B cell Dyscrasias
Serum Free Light Chain Assays Recommended by International Myeloma Working Group guidelines for B cell Dyscrasias The Specialist Protein Company Index Page Introduction to Freelite 1 What is Freelite?
More informationComparison of Serum Beta 2-Microglobulin and 24 hour Urinary Creatinine Clearance as a Prognostic Factor in Multiple Myeloma
J Korean Med Sci 2006; 21: 639-44 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences Comparison of Serum Beta 2-Microglobulin and 24 hour Urinary Creatinine Clearance as a Prognostic Factor
More informationGUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF MULTIPLE MYELOMA 2014
GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF MULTIPLE MYELOMA 2014 Jenny M. Bird 1, Roger G. Owen 2, Shirley D Sa 3, John A. Snowden 4, John Ashcroft 5, Kwee Yong 6, Gordon Cook 7, Sylvia Feyler 8, Faith
More informationTumor lysis syndrome (TLS) is a serious, lifethreatening
Case Report 70 Tumor Lysis Syndrome in Patients with Light Chain Multiple Myeloma: Report of Two Cases Hung Chang, MD; Shen-Yang Lee 1, MD; Tzung-Chih Tang, MD Tumor lysis syndrome (TLS) is a severe life-threatening
More informationConcise Review. of the Disease and Treatment Options. Improving Lives Finding the Cure. Multiple Myeloma Cancer of the Bone Marrow
Multiple Myeloma Cancer of the Bone Marrow Concise Review of the Disease and Treatment Options 2015 Edition Prepared by Brian G.M. Durie, MD A publication of the International Myeloma Foundation Improving
More informationPlasma Cell Disorders
Plasma Cell Disorders 2015 Subtypes of Plasma Cell Disorders Increased Plasma Cells Monoclonal Gammopathy Myeloma Macroglobulinemia (IgM) Increased / Altered Products of Plasma Cells Light Chain Amyloidosis
More informationMultiple Myeloma Understanding your diagnosis
Multiple Myeloma Understanding your diagnosis Multiple Myeloma Understanding your diagnosis When you first hear that you have cancer you may feel alone and afraid. You may be overwhelmed by the large amount
More informationSerum protein electrophoresis is a laboratory
Understanding and Interpreting Serum Protein Electrophoresis THEODORE X. O CONNELL, M.D., TIMOTHY J. HORITA, M.D., and BARSAM KASRAVI, M.D. Kaiser Permanente Woodland Hills Family Medicine Residency Program,
More informationMultiple Myeloma and Colorectal Cancer
Multiple Myeloma and Colorectal Cancer From Systems Immunology to Single Cells Leo Hansmann Mark M. Davis Lab Department of Microbiology&Immunology Stanford University Multiple Myeloma Monoclonal disease
More informationBackground Information Myeloma
Myeloma FAST FACTS Myeloma, also known as multiple myeloma, is a type of cancer that develops from plasma cells which originate in the bone marrow 1 Myeloma is the second most common type of blood cancer
More informationMoving Beyond RECIST
Moving Beyond RECIST Ihab R. Kamel, M.D., Ph.D. ikamel@jhmi.edu Associate Professor Clinical Director, MRI Department of Radiology The Johns Hopkins University School of Medicine Outline Standard measures
More information