I'm a 50-year-old male who has MGUS with an 0.5 g/dL (5 g/l) M-spike. I have not yet had a bone marrow biopsy. My labs are completely normal except for my M-spike.
My hematologist ordered a skeletal survey to have as a baseline for comparison for the future. Unfortunately, I have a 1.3 x 0.5 cm lytic lesion in my left humerus. It is within the central canal and not involving the cortex of the bone. I was sent for an MRI to evaluate the lesion, and I am still awaiting the results. No pain in that area at all.
It is my understanding that a clonal plasma cell lesion greater than 0.5 cm is considered a myeloma defining event. Is it standard in this kind of situation to start treatment for multiple myeloma?
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Entropy - Who do you know with myeloma?: Me (MGUS)
- When were you/they diagnosed?: April 2016
- Age at diagnosis: 48
Re: MGUS, but lesion found: is treatment next?
Hello Entropy,
I think you will need to have a bone marrow biopsy to determine whether you have a solitary plasmacytoma versus multiple myeloma. Your doctors also may decide to directly biopsy the lesion that was found to determine if it is due to a clonal plasmacytoma.
If the lesion is due to a plasmacytoma, but you have less than 10 percent clonal plasma cells in your bone marrow, then you'll have a solitary plasmacytoma, which may be treatable with just radiation.
If you have more than 10 percent clonal plasma cells in your bone marrow, and the lytic lesion is due to a plasmacytoma, you'll be considered to have multiple myeloma. The lytic lesion will mean that you meet the "B" (bone damage) in the "CRAB" set of myeloma-defining events. A diagnosis of multiple myeloma would in most cases mean that you would undergo myeloma treatment with one of the common treatment regimens. I suppose it's possible that your doctors also might choose to include radiation as part of your treatment.
Note that the 0.5 cm size cutoff that you mentioned applies to focal lesions, not lytic lesions. If someone who does not meet the CRAB criteria for a myeloma diagnosis nonetheless has two or more focal (not lytic) lesions, based on an MRI study, then they are considered to have a myeloma-defining event.
Focal lesions are areas of the bone marrow, inside the bone, that appear abnormal on an MRI. A lytic lesion is a lesion in the outer part of the bone.
Good luck, and keep us posted on what you find out.
I think you will need to have a bone marrow biopsy to determine whether you have a solitary plasmacytoma versus multiple myeloma. Your doctors also may decide to directly biopsy the lesion that was found to determine if it is due to a clonal plasmacytoma.
If the lesion is due to a plasmacytoma, but you have less than 10 percent clonal plasma cells in your bone marrow, then you'll have a solitary plasmacytoma, which may be treatable with just radiation.
If you have more than 10 percent clonal plasma cells in your bone marrow, and the lytic lesion is due to a plasmacytoma, you'll be considered to have multiple myeloma. The lytic lesion will mean that you meet the "B" (bone damage) in the "CRAB" set of myeloma-defining events. A diagnosis of multiple myeloma would in most cases mean that you would undergo myeloma treatment with one of the common treatment regimens. I suppose it's possible that your doctors also might choose to include radiation as part of your treatment.
Note that the 0.5 cm size cutoff that you mentioned applies to focal lesions, not lytic lesions. If someone who does not meet the CRAB criteria for a myeloma diagnosis nonetheless has two or more focal (not lytic) lesions, based on an MRI study, then they are considered to have a myeloma-defining event.
Focal lesions are areas of the bone marrow, inside the bone, that appear abnormal on an MRI. A lytic lesion is a lesion in the outer part of the bone.
Good luck, and keep us posted on what you find out.
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