[Dr. Ken Shain]

Re: Does my mother have multiple myeloma?

by Dr. Ken Shain on Tue Dec 24, 2013 9:14 am

Remember that myeloma, that is acitve multiple myeloma requiring therapy, lies on a continuum. This spans from MGUS (monoclonal gammopathy of underdetermined significance), smoldering (or inactive) myeloma, and active.

MGUS: <3g serum M-spike -- your 0.27 and <10% bone marrow plasmacytosis -- your mother 6% and an absence of end organ damage (no CRABI criteria). Observation is the most appropriate management strategy in that setting. For MGUS patients semiannual myeloma labs and annual bone surveys are the standard of care.

SMM: >3g and/or >10% plasma cells and no CRABI
AMM: any + CRABI (HyperCalcemia, Renal Failure, Anemia Boney Lytic lesions, and Infection (serious))

Your mother does have a noted yet mild anemia (the A of CRAB). I would make sure that she is checked for vitamin B12, folate, and iron deficiencies. It is unlikely that a 6% plasmacytosis and a 0.27g M spike is causing that degree of anemia. Importantly, it sounds like the bone survey and MRIs did not show any lytic disease.

Please enjoy the Holidays