What are the maximum values (such as for %multiple myeloma cells) for smoldering myeloma?
Thanks.
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Re: Maximum values for smoldering myeloma?
Hi John,
The Wikipedia article on multiple myeloma is a good quick reference for the criteria that distinguish between MGUS, smoldering myeloma, and (active, symptomatic) multiple myeloma.
http://en.wikipedia.org/wiki/Multiple_myeloma#Diagnostic_criteria
The key distinguishing feature between smoldering myeloma and multiple myeloma is not whether your M-spike is above a certain value or your plasma cell infiltration is above a certain percentage.
Rather, it is whether or not you have symptoms of the disease -- specifically, the so-called "CRAB" symptoms -- elevated calcium levels in the blood, kidney (renal) damage, anemia, or bone damage. (Some also feel the symptoms should be described as CRAB(I), with frequent infections being another symptom.)
As you'll see in the Wikipedia article, the criteria for a smoldering myeloma diagnosis are:
1. Serum paraprotein >30 g/L AND/OR
2. Clonal plasma cells >10% on bone marrow biopsy AND
3. NO myeloma-related organ or tissue impairment [i.e., no CRAB symptoms]
The criteria for a diagnosis of multiple myeloma are:
1. Clonal plasma cells >10% on bone marrow biopsy or (in any quantity) in a biopsy from other tissues (plasmacytoma)
2. A monoclonal protein (paraprotein) in either serum or urine (except in cases of true non-secretory myeloma)
3. Evidence of end-organ damage felt related to the plasma cell disorder (related organ or tissue impairment, ROTI, commonly referred to by the acronym "CRAB"):
- HyperCalcemia (corrected calcium >2.75 mmol/L)
- Renal insufficiency attributable to myeloma
- Anemia (hemoglobin <10 g/dL)
- Bone lesions (lytic lesions or osteoporosis with compression fractures)
The Wikipedia article on multiple myeloma is a good quick reference for the criteria that distinguish between MGUS, smoldering myeloma, and (active, symptomatic) multiple myeloma.
http://en.wikipedia.org/wiki/Multiple_myeloma#Diagnostic_criteria
The key distinguishing feature between smoldering myeloma and multiple myeloma is not whether your M-spike is above a certain value or your plasma cell infiltration is above a certain percentage.
Rather, it is whether or not you have symptoms of the disease -- specifically, the so-called "CRAB" symptoms -- elevated calcium levels in the blood, kidney (renal) damage, anemia, or bone damage. (Some also feel the symptoms should be described as CRAB(I), with frequent infections being another symptom.)
As you'll see in the Wikipedia article, the criteria for a smoldering myeloma diagnosis are:
1. Serum paraprotein >30 g/L AND/OR
2. Clonal plasma cells >10% on bone marrow biopsy AND
3. NO myeloma-related organ or tissue impairment [i.e., no CRAB symptoms]
The criteria for a diagnosis of multiple myeloma are:
1. Clonal plasma cells >10% on bone marrow biopsy or (in any quantity) in a biopsy from other tissues (plasmacytoma)
2. A monoclonal protein (paraprotein) in either serum or urine (except in cases of true non-secretory myeloma)
3. Evidence of end-organ damage felt related to the plasma cell disorder (related organ or tissue impairment, ROTI, commonly referred to by the acronym "CRAB"):
- HyperCalcemia (corrected calcium >2.75 mmol/L)
- Renal insufficiency attributable to myeloma
- Anemia (hemoglobin <10 g/dL)
- Bone lesions (lytic lesions or osteoporosis with compression fractures)
Re: Maximum values for smoldering myeloma?
Hi Beacon Staff,
I hadn't realized that they used corrected calcium to establish the HyperCalcemia criteria for an multiple myeloma diagnosis.
This is good to know, as it often seems the different multiple myeloma specialist groups have their own thresholds for that particular marker. I have been given different values by different multiple myeloma specialists, but as with everything myeloma, that is pretty much par for the course it seems. Just added this to my "question" list to discuss @ next appointment. Thanks for posting.
Best,
Dana H
I hadn't realized that they used corrected calcium to establish the HyperCalcemia criteria for an multiple myeloma diagnosis.
This is good to know, as it often seems the different multiple myeloma specialist groups have their own thresholds for that particular marker. I have been given different values by different multiple myeloma specialists, but as with everything myeloma, that is pretty much par for the course it seems. Just added this to my "question" list to discuss @ next appointment. Thanks for posting.
Best,
Dana H
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DanaH - Who do you know with myeloma?: Myself, SMM as of 1/2012
- When were you/they diagnosed?: 1/2012
- Age at diagnosis: 54
Re: Maximum values for smoldering myeloma?
For those who are interested, there was an extended discussion here in the forum in December about the criteria for a multiple myeloma diagnosis versus a smoldering myeloma diagnosis. It's at this link:
https://myelomabeacon.org/forum/does-my-mother-have-multiple-myeloma-t2643.html
It gets a bit technical at times, but it links to some useful sources and also clarifies that there are some differences in the critiera, depending on the source you consult.
https://myelomabeacon.org/forum/does-my-mother-have-multiple-myeloma-t2643.html
It gets a bit technical at times, but it links to some useful sources and also clarifies that there are some differences in the critiera, depending on the source you consult.
-
JimNY
Re: Maximum values for smoldering myeloma?
Are there any physicians who treat smoldering myeloma? My husband has some of the "CRAB" symptoms along with the mental confusion and hallucinations. He has had a complete work up by a neurologist whose father died of multiple myeloma. After all the tests came back negative, the neurologist stated he believed his mental confusion and hallucinations are related to his multiple myeloma.
Our treating facility still will not begin any type of treatment. He is 74 years old and was in very good health until August of 13 when he was diagnosed.
Thanks,
Janis
Our treating facility still will not begin any type of treatment. He is 74 years old and was in very good health until August of 13 when he was diagnosed.
Thanks,
Janis
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Janis Weaver - Name: Janis Weaver
- Who do you know with myeloma?: My Husband
- When were you/they diagnosed?: August 16, 2013
- Age at diagnosis: 72
Re: Maximum values for smoldering myeloma?
An article in the December issue of the Journal of the American Society of Hematology by Mayo physicians had this excerpt in the summary--
"This unique study (Spanish study showing better survival in high risk patients that were treated with Revlimid and Dex) prompted us to review current knowledge about SMM and address the following questions: (1) Are there patients currently defined as SMM who should be treated routinely? (2) Should the definitions of SMM and multiple myeloma be reconsidered? (3) Has the time come when not treating is more dangerous than treating? (4) Could unintended medical harm result from overzealous intervention? Our conclusion is that those patients with the highest-risk SMM (extreme bone marrow plasmacytosis, extremely abnormal serum immunoglobulin free light chain ratio, and multiple bone lesions detected only by modern imaging) should be reclassified as active multiple myeloma so that they can receive MM-appropriate therapy and the paradigm of careful observation for patients with SMM can be preserved."
http://bloodjournal.hematologylibrary.org/content/122/26/4172.full.pdf+html
A chart on page 8 shows their criteria for reclassifying SMM and active multiple myeloma with indications of when to treat.
These slides show how Mayo uses cytogenic information to stratify risk of progression--
http://www.msmart.org/newly%20diagnosed%20myeloma.pdf
Of course, this is the Mayo consensus and as I've seen in some of the webcasts from the 2013 ASH meetings, this perspective isn't shared across all the experts and, based on what I've seen, Mayo seems to be pretty conservative when it comes to recommending treatment.
Kathy
"This unique study (Spanish study showing better survival in high risk patients that were treated with Revlimid and Dex) prompted us to review current knowledge about SMM and address the following questions: (1) Are there patients currently defined as SMM who should be treated routinely? (2) Should the definitions of SMM and multiple myeloma be reconsidered? (3) Has the time come when not treating is more dangerous than treating? (4) Could unintended medical harm result from overzealous intervention? Our conclusion is that those patients with the highest-risk SMM (extreme bone marrow plasmacytosis, extremely abnormal serum immunoglobulin free light chain ratio, and multiple bone lesions detected only by modern imaging) should be reclassified as active multiple myeloma so that they can receive MM-appropriate therapy and the paradigm of careful observation for patients with SMM can be preserved."
http://bloodjournal.hematologylibrary.org/content/122/26/4172.full.pdf+html
A chart on page 8 shows their criteria for reclassifying SMM and active multiple myeloma with indications of when to treat.
These slides show how Mayo uses cytogenic information to stratify risk of progression--
http://www.msmart.org/newly%20diagnosed%20myeloma.pdf
Of course, this is the Mayo consensus and as I've seen in some of the webcasts from the 2013 ASH meetings, this perspective isn't shared across all the experts and, based on what I've seen, Mayo seems to be pretty conservative when it comes to recommending treatment.
Kathy
-
koontzkg - Name: Kathy
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2/2013
- Age at diagnosis: 51
Re: Maximum values for smoldering myeloma?
Janis,
Regarding
"...Are there any physicians who treat smoldering myeloma? My husband has some of the crab symptoms along with the mental confusion and hallucinations....Janis"
By definition, if one has ANY one of the CRAB symptoms, one is NOT smoldering. Provided there is a verified diagnosis for some level of multiple myeloma, your husband would be classified as having symptomatic multiple myeloma if he met any of the CRAB criteria and should be seeking treatment.
I realize this is an overused question/piece-of-advice, but is your husband working with a doctor that specifically specializes in multiple myeloma?
Regarding
"...Are there any physicians who treat smoldering myeloma? My husband has some of the crab symptoms along with the mental confusion and hallucinations....Janis"
By definition, if one has ANY one of the CRAB symptoms, one is NOT smoldering. Provided there is a verified diagnosis for some level of multiple myeloma, your husband would be classified as having symptomatic multiple myeloma if he met any of the CRAB criteria and should be seeking treatment.
I realize this is an overused question/piece-of-advice, but is your husband working with a doctor that specifically specializes in multiple myeloma?
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Maximum values for smoldering myeloma?
Kathy posted on another thread that they are trying to redefine myeloma and stated that if you have any of the following, you are NOT smoldering, but really are early stage multiple myeloma: 1) >60% plasma cells 2) High FLC (>100) 3) >1 focal lesion on MRI.
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gardengirl - Name: gardengirl
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Nov. 2013
- Age at diagnosis: 47
Re: Maximum values for smoldering myeloma?
Here's a diagram showing the criteria you described, gardengirl.
http://bloodjournal.hematologylibrary.org/content/122/26/4172/F4.large.jpg
http://bloodjournal.hematologylibrary.org/content/122/26/4172/F4.large.jpg
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koontzkg - Name: Kathy
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2/2013
- Age at diagnosis: 51
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