[Beacon Staff]

Critical look - new multiple myeloma diagnostic criteria

by Beacon Staff on Mon May 18, 2015 1:38 pm

There's an article out today in Clinical Oncology News that discusses the new diagnostic criteria for multiple myeloma that were published last year and discussed in Dr. Rajkumar's article for The Beacon, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders" (Oct 26, 2014).

The author of the new article writes:

In a thoughtful and precise paper, the International Myeloma Working Group (IMWG) last fall expanded the definition of multiple myeloma to include 3 groups of asymp­tom­atic individuals as patients with the disease, because of data that each group is highly likely to develop organ or bone damage within 2 years ...

I initially worried that these new disease definitions might lead to frequent over­treat­ment, especially when decisions to treat the patient as overt multiple myeloma are left to busy physicians who mechanically apply guidelines. On reflection, these considerations are outweighed by the benefits to thoughtful and conscientious physicians and their patients of expanding the disease definitions to include these ominous situations.

You can read the full article here:

S Vogl, "Diagnostic Expansion in multiple myeloma: Elegant, Thoughtful, but Risky," Clinical Oncology News, May 1, 2015 (full text of article)

What do you see as the main points in the article? Was there anything that surprised you, or which you found particularly interesting?

[8oclockcoffee]

Re: Critical look - new multiple myeloma diagnostic criteria

by 8oclockcoffee on Mon May 18, 2015 11:02 pm

All I can say is that Dr. Steven Vogl has only treated two multiple myeloma patients in his long career.

In my career, I have cared for 2 patients with overt multiple myeloma, each with multiple lytic bone lesions and a big protein spike, who have been stable for decades off treatment – for reasons I cannot explain."

I think I would prefer to make treatment decisions with a myeloma specialist who knows the in­tricacies of this disease and the treatment options available.

Just my thoughts on this article. I am sure he is a good doctor.

[Jonah]

Re: Critical look - new multiple myeloma diagnostic criteria

by Jonah on Mon May 18, 2015 11:59 pm

I read that statement different than you did, 8oclockcoffee. I don't think he meant to say that he's only had two multiple myeloma patients in his entire career. Instead, I think he meant to say that, among all the myeloma patients he's had during his career, he's had two that would have been classified as having multiple myeloma requiring treatment, but who he didn't treat, and their disease remained stable for many years even though they didn't receive treatment.

I actually found that part of the article really interesting, and I think he makes some good points in general about how the new criteria really shouldn't be used as an instant justification for starting to treat patients.

[8oclockcoffee]

Re: Critical look - new multiple myeloma diagnostic criteria

by 8oclockcoffee on Tue May 19, 2015 10:40 am

Hi Jonah,
I see where you would think that as well.
I took another look at the sentence and broke it down a little more:
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I think when he says "I have cared for 2 patients" - I take that as he treated these patients. (I may be wrong)

Then he says - "each with multiple lytic bone lesions and a big protein spike" - I take that he is stating that they met the criteria for treatment.

He also says - "who have been stable for decades off treatment" - I take that also as a clue that he did treat the patients, but now they have been stable for decades.
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I am interested in this too. As my dad was diagnosed with multiple myeloma 20 years ago. He was treated with Thalidomide and Prednisone and has remained stable for 20 years, although he has battled two other cancers as well as Myelofibrosis. When I met with my dad's doctor last year, he told me that my dad probably had SMM and that with today's criteria they would have 'watched and waited'.

My dad had no m-spike and several large lytic lesions in his skull and femur. I am glad that the doctor knew to test for FLC's and realized that he had the non-secretory multiple myeloma or SMM. Since my dad's father and sister both died from multiple myeloma - not caught in time - he treated my dad.

Now I am the one who is being watched and is waiting. My m-spike (2.3) and FLC's (ratio 15.47) continue to increase. My hemoglobin and calcium like to flirt with the danger zone. I have an m-spike and Bence Jones Protein in my urine and I hurt like hell. I have a pathological fracture in my tibia that doesn't want to heal and am waiting for the results of a third BMB as I write.

I am so tired of watching and waiting while my life goes to pot. I am not 50 yet and feel like a 90 year old. In fact my dad (age 81) has more energy and stamina than I do.

I think that if I had Dr. Vogl - I would be looking for a new doctor.

That again is just my opinion...