[Jason D]

Macrofocal Myeloma

by Jason D on Thu May 20, 2010 10:53 pm

Dear Dr. Hofmeister,

I am a 53-year-old female, and was diagnosed with light chain only (kappa) last year, with multiple lytic lesions all over my skeleton. But I had no anemia (Hgb 14), no hypercalcemia, no renal dysfunction, no LDH or B2M elevation, and normal IgG, IgA, and IgM. Additionally, FISH detected no 4;14, 14;16, or del 17p, and I had a normal karyotype. PET-CT showed multiple lytic lesions with no corresponding hypermetabolic activity. The original aspirate showed 15% plasma cells with normal cellularity. My CBC was perfectly normal. How do you properly differentiate typical multiple myeloma from macrofocal multiple myeloma? And how do you monitor it, and do you treat it differently from typical multiple myeloma?

[Dr. Craig Hofmeister]

Re: Macrofocal Myeloma

by Dr. Craig Hofmeister on Fri May 21, 2010 10:50 pm

Macrofocal myeloma, a term coined by Bart Barlogie (and I'll essentially quote him here), describes the fact that patchy bone marrow involvement is a common feature of myeloma, readily appreciated by MRI and PET-CT scanning. In cases of predominantly macrofocal disease presentation, iliac crest sampling sites may be uninvolved and account for negative MFC results, despite an enormous tumor load residing in focal sites. MRIs done at larger centers with intense interest in MRI to evaluate bone disease in Germany (Heidelberg Germany, Little Rock Arkansas, etc.) can be done to evaluate for the presence of pockets of bony myeloma and the detection of these pockets of myeloma cells in patients with normal skeletal surveys (i.e. x-rays of large bones that showed no myeloma), correlates with survival.

So what to do after getting all these MRIs? Well that's still months to years to never away. Stay tuned.

Most folks would think of you as essentially newly diagnosed kappa light chain myeloma, international stage I, with no distinguishing features and would follow your response 24hr urine total protein, 24hr urine protein electrophoresis, and serum kappa light chains by Freelite assay. I would not treat you differently than any other stage I myeloma patient with extensive myeloma bone disease.