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Most likely CRAB symptom at relapse?
If lytic lesions were the only clinical sign of multiple myeloma a patient had at diagnosis, would new lytic lesions also be the patient's most likely "CRAB" symptom to occur at clinical (not serologic) relapse?
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coachhoke - Name: coachhoke
- When were you/they diagnosed?: Apri 2012
- Age at diagnosis: 71
Re: Most likely CRAB symptom at relapse?
Relapse is always a difficult thing to think about. No one wants to have progressive disease. As you stated, most patients will be found to have serological or biochemical progression, meaning that we catch the progression with increasing serum or urine M-spikes, or increasing serum free light chains. It is critical that your multiple myeloma oncologist keeps an eye all of these parameters. Especially serum M-spike and serum free light chain; following just SPEP (serum M-spike) or quantitative immunoglobulins is not sufficient..
The CRAB criteria are the classic signs of end organ damage associated with active multiple myeloma:
C: hyperCalcemia,
R: Renal failure / insufficiency (kidneys)
A: Anemia (low hemoglobin as a measure of reds cells), and
B: bony lytic lesions.
Most patients will present with 1 or more (sometimes all) of these issues at diagnosis.
Generally speaking, a patient's first active signs of relapses will parallel their diagnosis. If it was bone lesions, likely new lesions. Anemia as a presentation, then dropping hemoglobin.
However, this does not mean that a patient's myeloma may not change and, therefore, present with an alternate aspect of CRAB. As such, we continue to monitor all the characteristics.
Ideally, we (oncologist and patients) are keeping an eye on the quantity and the rate of biochemical relapse and initiate therapy prior to active relapse. Unfortunately, multiple myeloma can progress rapidly, presenting with new bone lesions, fractures, acute renal failure and/or hypercalcemia. This is why it is critical that patients, caregivers, and doctors need to keep an eye out.
The CRAB criteria are the classic signs of end organ damage associated with active multiple myeloma:
C: hyperCalcemia,
R: Renal failure / insufficiency (kidneys)
A: Anemia (low hemoglobin as a measure of reds cells), and
B: bony lytic lesions.
Most patients will present with 1 or more (sometimes all) of these issues at diagnosis.
Generally speaking, a patient's first active signs of relapses will parallel their diagnosis. If it was bone lesions, likely new lesions. Anemia as a presentation, then dropping hemoglobin.
However, this does not mean that a patient's myeloma may not change and, therefore, present with an alternate aspect of CRAB. As such, we continue to monitor all the characteristics.
Ideally, we (oncologist and patients) are keeping an eye on the quantity and the rate of biochemical relapse and initiate therapy prior to active relapse. Unfortunately, multiple myeloma can progress rapidly, presenting with new bone lesions, fractures, acute renal failure and/or hypercalcemia. This is why it is critical that patients, caregivers, and doctors need to keep an eye out.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Most likely CRAB symptom at relapse?
Thank you, Dr. Shain, for answering my question.
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coachhoke - Name: coachhoke
- When were you/they diagnosed?: Apri 2012
- Age at diagnosis: 71
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