[DanaH]

Difference between bone lesions, bone thinning & CRAB

by DanaH on Sun Apr 07, 2013 5:03 pm

Would anyone be able to help me understand the CRAB criteria, specifically the "B" Bone Involvement. I am so confused. I have bone thinning, osteopenia, per a most recent DEXA scan. My PET/CT and MRI for bone lesions were normal, so no lesions.

I am smoldering and currently on Zometa IV every 3 months.

I don't fully understand if the osteopenia is considered as the "B" in CRAB. I am post menopausal and was told no one can definitely say if the multiple myeloma is contributing to the bone demineralization or if is more hormone related, but as a precautionary method, was started on the Zometa to slow the process down.

I have CD126 positive plasma cells in my bone marrow biopsy (BMB) and I understood that to mean the IL-6 receptor is causing the osteoclasts activity to increase.

I may not be right on any of this, but I am trying to understand if I have the "B" criteria of the CRAB, which should then require "real" treatment against the multiple myeloma?

Thanks to anyone who can help me grasp this concept.

Best,
Dana H.

[DanaH]

Re: Difference between bone lesions, bone thinning & CRAB

by DanaH on Sun Apr 07, 2013 5:11 pm

Oh, and I should add, that my first DEXA in September, 2010 reflected the beginning of mild osteopenia, mild bone loss ... my followup DEXA in September, 2012 reflected the beginning of severe osteopenia, with interim demineralization since 2010.

I was diagnosed with MGUS in December, 2010 and smoldering myeloma in January, 2012

Thank you.

[Dr. Adam Cohen]

Re: Difference between bone lesions, bone thinning & CRAB

by Dr. Adam Cohen on Sun Apr 07, 2013 10:48 pm

Dear Dana H,

Lytic bone lesions visible on X-rays or other radiologic tests reflect active myeloma and are an indication for treatment. Severe osteopenia or osteoporosis also is technically included under "B" in the CRAB criteria. However, unless there is a significant history of fractures, I do not usually initiate anti-myeloma therapy for osteopenia alone, and would concur with just Zometa and close observation.

This is an individualized decision that should be made by each patient and his/her oncologist.

Hope this helps.

[DanaH]

Re: Difference between bone lesions, bone thinning & CRAB

by DanaH on Sun Apr 07, 2013 11:20 pm

Dear Dr. Cohen,

Thank you so very much for your response. Your explanation most certainly helps as I was confused as to whether diffuse bone disease was classified under the "B" since my research / searches would always point to "bone disease / involvement" and the specific term "lesions" as the "B" criteria.

I have no history of any fractures so it seems my oncologist is following a similar treatment protocol as you describe above.

Thanks again Dr. Cohen and have a great night.

Best to you,
Dana H.

[DanaH]

Re: Difference between bone lesions, bone thinning & CRAB

by DanaH on Sun Apr 07, 2013 11:49 pm

I do have a follow-up question which is making me nervous. if I do have the "B" in CRAB criteria due to the diffuse bone involvement, then wouldn't I have active disease and no longer be classified as smoldering?

I apologize for not including that in my previous response.

Thanks so much and best regards,
Dana H.